The AfroCentric Health Group (AfroCentric) and global analytics software firm FICO today announced a strategic partnership that establishes the South African healthcare industry’s leading fraud management solution. AfroCentric’s healthcare IT services subsidiary, Helios IT Solutions (Helios ITS), and FICO now offer this fraud management and payment integrity platform to all medical schemes in South Africa.
FICO® Insurance Fraud Manager uses adaptive predictive analytic models that are integrated within purpose-built software, giving medical schemes (payers) a vastly enhanced ability to identify and address existing and emerging losses from fraud, waste and abuse. Medical schemes can use this solution, deployed through Helios ITS’ secure technological offering, to detect, review and investigate suspicious claims, members and providers, and deliver cost-effective quality care with integrity.
The cutting-edge fraud detection system employs predictive analytics to detect and reduce fraud, waste and abuse at the claim, provider and procedure levels. Importantly, the solution enables schemes to augment their existing payment integrity capabilities. To read the full story click on the link below.
Source: FICO Press Release