SAS, the leader in massively parallel analytics and artificial intelligence (AI), is lauded as the best-in-class vendor in Aite Matrix: Payment Integrity in Healthcare. SAS’ stability, brand recognition, and product features and functionality collectively bested those of its competitors in Aite Group's inaugural assessment of eight leading payment integrity solution purveyors.
Whether by inadvertent error or malicious fraud, payment integrity issues bleed an astounding $800 billion annually from the US health care system by some estimates. SAS® analytics detect and prevent health care fraud, waste and abuse at every stage of the claims process, helping stop improper payments before claims are paid.
“Health care payers are on a quest to make informed decisions as they strive to optimize their claims processing and payment operations. Payment integrity tools play an important role in these optimization initiatives,” said Inci Kaya, Senior Analyst of Aite Group’s Health Insurance practice. “SAS excels in features and functionality, enhanced by an intuitive user interface, ease of implementation and integration, and its customization support.”
As accelerating digitization fuels the industry’s shift from pay-and-chase to prevent-and-pay defenses, the strength and integration of an organization’s analytics and AI capabilities become ever more critical. Combining rules, anomaly detection and predictive analytics, SAS Detection and Investigation for Health Care on SAS® Viya® helps commercial insurers, government payers, health plans and pharmacy benefits managers identify and investigate erroneous, incomplete, suspicious and inaccurate claims.
According to Aite Group’s analysis (aitegroup.com), SAS’ legacy and strength in data analytics and aggregation come into play at a time when health plans can benefit from robust analytics capabilities to uncover irregular claim submissions. Building on its core competence, SAS analyzes health care claims data using a package of over 1,400 scenarios that trigger alerts, accompanied with a risk value. Aite Group notes SAS’ core strengths include:
• Cutting-edge and flexible tools.
• Experience in fraud, waste and abuse (FWA) and health analytics.
• Competitive pricing and comprehensive solution.
• Visual social network analysis capabilities that identify recipients with multiple providers.
The report extols the software’s capabilities, highlighting that,“The solution includes components for detection, alert management and disposition, along with predefined investigation workflows, content management and advanced analytics. It also includes link analytics to detect and visualize hidden risky fraud rings, collusive networks and relationships among health care entities otherwise invisible to investigators.”
“Focusing beyond the claims department, more and more health care organizations are taking an enterprise approach to detecting and investigating FWA throughout the entire claims process,” said Stu Bradley, Senior Vice President of Fraud and Security Intelligence at SAS. “SAS’ end-to-end solution combines the four essential disciplines data management, behavioral analytics, claim analytics and clinical targeting in a single, complete, enterprise platform. This helps our customers make more informed payment decisions while positioning them to seize the advantages of cloud deployments and real-time processing,”
To learn how a platform approach can help payer organizations gain efficiencies while reducing FWA, download the payment integrity white paper Achieving Program Integrity for Health Care Cost Containment Operations.
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