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RiSIC - Stop losing money. Today.

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Artificial Intelligence powered risk classification system for detection of waste, abuse and fraud in healthcare insurance claims tailored for GCC region

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RiSIC - Stop losing money. Today.

  1. 1. I am Kiril Milev Managing Director of Netcetera Middle East kiril.milev@netcetera.com Hello!
  2. 2. Innovation Data BenefitsStandardization
  3. 3. 10%lost in waste, abuse and fraud
  4. 4. The Concept RiSICclaims tagged claims reporting configuration
  5. 5. The Concept RiSICclaims prediction outcome training feedback
  6. 6. “No consultations, high number of labs esp. influenza, CULTURE AEROBIC IDENTIFY. Billing of many CPTs under his name by many different providers” “Nephrologist doing unrelated labs like chest xray, ecg for usg, rft for hypertension and medicine is only antihypertensive” “GP billing for specialist, injections given with no bill for drugs, over prescription of risek, multivits for acute urti” “Overbilling of CPTs, the number of CPTs is inconsistent with the number visits, Upcoding of ICDs”. “Pediatric in <provider>, billing for consultant code NN when he is specialist, over investigation with viral tests, TSH, with no relevant medication given” Real WAF cases detected by RiSIC “Over investigation with eye ultrasound even in case conjunctivitis, chalazion and dry eye”. “Pediatric consulting adults and billing specialist fee”
  7. 7. Results RiSIC adds 69% more savings which increases the denial rate from 5% to 8.4% RiSIC identifies 80% of the existing denials
  8. 8. Kiril Milev kiril.milev@netcetera.com +971 50 903 8552 Thanks!

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