4L Data Intelligence™
The 4L Data Intelligence website is for a company that offers AI-based solutions to detect and prevent fraud, waste, and abuse in the healthcare industry. Their “Integr8” AI technology uses advanced computer algorithms and language processing to examine claims data immediately, detect recurring patterns of suspicious behavior, and highlight potential cases of fraudulent activity for further investigation.
Here are some things that the 4L Data Intelligence AI tool can do:
- Real-time fraud detection: The tool can quickly analyze data about claims to find possible cases of fraud, waste, and abuse. This helps stop fraud from happening in the beginning.
- Pattern recognition: The tool uses a type of technology called machine learning to find patterns of activity that seem suspicious. This helps find FWA cases that may not be easy for humans to spot.
- Natural language processing: The tool can understand what claims data means. This helps to find cases of fraud, waste, and abuse that are not easily noticed.
- Customizable alerts: The tool can be set up to create alerts for certain types of FWA cases. This helps make sure that no situations are overlooked.
- Data mining: This method is used to find patterns and trends in information. The 4L Data Intelligence AI tool uses data mining to find patterns of suspicious activity. For example, it looks for claims that are submitted multiple times for the same service or claims that are submitted for services that are not needed for medical reasons.
- Machine learning: This method is used to teach models how to anticipate future actions. The 4L Data Intelligence AI tool uses machine learning to teach models that can guess which claims are probably fake.
- Natural language processing: This method is used to comprehend the significance of written information. The 4L Data Intelligence AI tool helps understand medical codes in claims data using natural language processing. This helps the tool find FWA cases that are not easily noticed.
- Duplicate claims: This happens when a request is made for the same service more than once.
- Unbundling: This happens when one service is charged as several services.
- Upcoding: This happens when a service is charged more than it should be.
- Unnecessary services: This happens when you are charged for services that you don’t really need for your health.
- Provider collusion: This happens when providers collaborate to engage in fraudulent activities.
