Healthcare Fraud Shield
Member Level: SilverVendor Overview
Description of Services: Healthcare Fraud Shield offers a fully integrated Fraud, Waste and Abuse software solution platform called FWAShield. FWAShield utilizes unique and proprietary data sources to maximize Return on Investment (ROI) and achieve superior results. Our platform is deployed utilizing a Software-as-a-Service model which allows us to quickly adopt new system enhancements and fraud analytics with minimal work for our customers. Our platform is designed to make the user experience simple, fast, and effective. FWAShield integrates distinctive algorithms and an expert rules-based methodology to reduce the excessive and unwanted false positives present in most other fraud detection software programs.
Primary Service: Claims
Secondary Service: Enterprise Data
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16052 Swingley Ridge Road
Suite 200
Chesterfield, MO 63017
888-333-8140
https://www.hcfraudshield.com/
Documents
Presentation: Imitation is the sincerest form of Fraud?
Healthcare Fraud Shield walks through the uncovering of a case of billing for services not rendered, using the emergency room for non-emergent services and impersonation in the hopes of pushing payments along.
Presentation: Imitation is the sincerest form of Fraud?
Healthcare Fraud Shield will walk attendees through the uncovering of a case of billing for services not rendered, using the emergency room for non-emergent services and impersonation in the hopes of pushing payments along.
Recording: Data Blending Across Payers to Combat Fraud, Waste and Abuse
Healthcare Fraud Shield will show attendees in this video recording how combining data from multiple payers can be analyzed to detect and prevent fraud, waste and abuse in the healthcare industry.
Brochure: Company Overview
Based in Chesterfield, Missouri, Healthcare Fraud Shield offers innovative fraud, waste, and abuse (FWA) software and services to healthcare insurance payers. Healthcare Fraud Shield’s fraud, waste, and abuse platform, FWAShield™, is an integrated, SIU specific solution consisting of: PreShield™ (pre-payment analytics and claim review logic), PostShield™ (post-payment analytics), RxShield™ (pharmacy and pharmaceutical specific analytics), AIShield™ (A.I. driven natural language generated analytic insights), CaseShield™ (SIU case management for investigations), QueryShield™ (ad-hoc querying and reporting tool), PostShield Shared Analytics™ (de-identified, multi-client combined claim insights).
Presentation: Enhanced identification of Emerging Fraud Schemes by Embedding AI and rapidly deploying targeted rules - including COVID-19 schemes
Healthcare Fraud Shield discusses what they are seeing in fraud activity today with particular focus on COVID-19 related schemes and behaviors that are just now beginning to appear in claims data. They also describe how they are using AI to gain new insights into as yet "undefined" fraud schemes and then leverage these new insights to improve our rules-based alerts.
Recording: Enhanced identification of Emerging Fraud Schemes by Embedding AI and rapidly deploying targeted rules - including COVID-19 schemes
During this video presentation with Healthcare Fraud Shield you will learn about fraud activity today with particular focus on COVID-19 related schemes and behaviors that are just now beginning to appear in claims data.
Brochure: Overview of FWAShield
We provide our software using the Software as a Service model of software delivery. This allows Healthcare Fraud Shield to deliver the highest quality software and support services in an effective manner and without impacting our clientâ??s information technology infrastructure and resources.
Recording: SIU Data Analytics Tool Success Story
Kristin Griego at Prominence shares an overview of steps they took to evaluate and select Healthcare Fraud Shield as their vendor and share some of the key areas they were looking for in their vendor search and lessons learned. Karen Weintraub from Healthcare Fraud Shield demonstrates the tool and answers members' questions.
Presentation: SIU Data Analytics Tool Success Story
Kristin Griego at Prominence shares an overview of steps they took to evaluate and select Healthcare Fraud Shield as their vendor and share some of the key areas they were looking for in their vendor search and lessons learned. Karen Weintraub from Healthcare Fraud Shield demonstrates the tool and answers members' questions.