HIBIS (Health Insurance Business Intelligence System) is our Fraud, Abuse, Waste detection product, that stands at the forefront of compliance and payment integrity operations. HIBIS allows healthcare payers to accurately and efficiently prevent and recover inappropriate claiming by detecting billing anomalies and supporting workflow required to recover incorrect payments.
Harnessing the power of HIBIS users can:
- Process claims through a high performance rules engine
- Navigate claims and related alerts information using context-specific and clear explanations
- Supervised machine learning on a payer’s case management history, guiding users towards high value alerts
- Support analyst workflow while capturing actions and results
- Deliver flexible and comprehensive management reporting
HIBIS possesses an ever-expanding set of 650 rules. New rules are continually developed in response to both newly detected anomalous behaviours and client requests as well as in-house research into new compliance issues.