Green Shield Canada (GSC) and HBM+ (its health benefit management solutions provider division) announced on March 6 a fraud prevention and detection strategy centred on artificial intelligence and housed under the new Claim Watch banner.
GSC notes that claims data “which comes in a huge volume in all forms and from all directions” is extremely time consuming to analyze. However, the company’s new AI platform “not only finds and compiles all kinds of data at tremendous speeds, but also identifies patterns and less obvious outliers at a deep enough level to unearth suspicious activity earlier than in the past,” stated the company in an announcement.
A game-changer in fraud detection
“We’re very proud of what GSC and HBM+ do in the fraud detection and prevention space,” says Brent Allen, GSC’s vice president of service operations. “In the past, preventing and detecting fraud involved manual processes…essentially the focus was on following a paper trail. We were trying to find a needle in a haystack.”
However, the AI platform “is a game-changer in bringing together all our data on claims, health providers and plan members to form instant insights,” says Allen. “The richness of our data is a true differentiator in our industry, and that haystack quickly becomes less daunting with an AI-powered microscope.”
With Claim Watch, fraud detection is also enhanced by the fact that claims are paid through a single system to the AI platform without being outsourced, says GSC. Also, a provider registry ensures that the applicable credentials and licences are in place for any provider submitting claims online via the providerConnect portal.