Healthcare Fraud Shield

Website: www.hcfraudshield.com

Healthcare Fraud Shield specializes in fraud, waste, abuse, & error detection and payment integrity for healthcare payers nationally by efficiently stopping claims prior to payment, utilizing post-payment advanced analytics, artificial intelligence, and shared client data insights. We save health plans millions annually incremental to existing pre-payment processes using our unique and proven approach. HCFSPlatformTM offers the combination of targeted rules, artificial intelligence, and shared analytics across multiple payers resulting in higher ROI (up to 20:1 or more) compared to other vendors.

The HCFSPlatformTM was developed by industry leading healthcare subject matter experts and is a component of over 60+ clients including 7 of the 10 largest commercial insurers in the US. Our client satisfaction rating is exceptional with a net promoter score of 94 and client retention rate over 95%. HCFSPlatformTM is a fully integrated platform consisting of PreShield (prepayment analytics & claim review logic), PostShield (post-payment analytics), AIShield (AI-driven analytic insights), RxShield (pharmacy and pharmaceutical specific analytics), Shared Analytics, CaseShield (SIU/PI case management), QueryShield (ad hoc query and reporting tool), HCFSServices (data mining, investigative, and record reviews), and AuditPlusTM (Medical Record Review & SVRS).