Gamma is a platform for identifying and investigating inappropriate healthcare claiming patterns. Where HIBIS focuses on individual claims, Gamma extends this by using a risk scoring approach to evaluate the totality of provider claiming behaviour.
Optimal payment system integrity can only be achieved if payers go beyond the analysis of individual healthcare claims: the entire claiming profile of medical providers also needs to be taken into account. Gamma is our next generation analytics tool that uses a flexible analytical framework to assess provider claiming trends across a range of behavioural indicators. The platform can be adapted to monitor a range of different activities, such as non-provision of care, misrepresentation of services or the delivery of medically unnecessary procedures, at any level – e.g. provider, practice, or hospital.
Gamma possesses prioritised workflow tools to enable users to:
- Identify and prioritise anomalous claiming behaviour
- Assess areas of concern for each lead with contextual claiming data
- Triage and allocate cases for investigation and resolution
Gamma’s combination of advanced analytics, data visualisation techniques and workflow tools ensure that operational efforts focus on cases that will return the highest value for payers.