HIBIS, Lorica Health’s rule-based FWA (fraud, waste, abuse) detection product, stands at the forefront of compliance and payment integrity operations. HIBIS allows healthcare payers to accurately and efficiently prevent and recover inappropriate claiming. HIBIS detects billing anomalies and supports workflows required to recover incorrect payments.
Harnessing the power of HIBIS our clients can:
- Process claims through a high performance rules engine
- Navigate claims and related alerts information
- 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.
In response to customer feedback Lorica has recently developed HIBIS Express: an innovative module that adds a machine learning layer to HIBIS.