Smarter methodology goes beyond analytics.
Partner with SmartLight Analytics -- an independent expert in claims adjudication, analytics and clinical health services -- to review claims outside of your benefit administrator’s internal process to systematically and routinely review claims for waste, fraud, abuse that result in overspending.
What does best practice of this independent review look like with SmartLight?
- Ensures regular monitoring of claims – ideally each claim is reviewed monthly, to allow for immediate intervention, leading to substantial savings and refunds applied towards the plan funds,
- Analyzes 100% of claims using advanced inferential analytic methods,
- Utilizes clinical and adjudication expertise to minimize false positives, and
- Avoids conflict of interests when selecting service providers.
SmartLight Analytics combines the best inferential analytic models with a team of experts with deep industry knowledge of both health insurance data and clinical knowledge.
You don't need a solution that leaves you with more questions than answers. At SmartLight, we combine the best inferential analytic models with a team of clinical experts with deep industry knowledge. Inferential methods deliver superior results by using dynamic processes that are customized to your specific employee health population. In other words, we let your data tell us where to look – without preconceived notions about what the errors are beforehand. This approach consistently drives higher results in wasteful spend detection compared to traditional rule-based methods.
Our decades of experience means we can be your advocate throughout the process to ensure that maximum cost reductions are implemented. This comprehensive approach is why we consistently reduce healthcare costs by 3-5% for our customers.