Smarter methodology goes beyond analytics:
Your data tells us where to look
As an independent expert in claims adjudication, analytics and clinical health services, SmartLight’s team reviews claims outside of your benefit administrator’s internal process to systematically and routinely review claims for waste, fraud, and abuse that result in overspending.
What does best practice of this independent review look like with SmartLight?
- Ensures regular monitoring of claims. Ideally, we review claims monthly, to allow for immediate intervention, leading to substantial savings and refunds applied toward the plan funds,
- Analyzes 100% of claims using advanced inferential analytic methods,
- Utilizes clinical and adjudication expertise to minimize false positives,
- Avoids conflict of interests when selecting service providers.
SmartLight Analytics combines the best inferential analytic models with a team of experts who have 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. Inferential methods deliver superior results using dynamic processes customized to your specific employee health population. In other words, your data tells 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.
Because of our decades of experience, 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.
Minimal employer resources, ZERO employee participation.
Unique, employer-centric data models that are layered with statistical and clinical input then weighted to create the highest true positive rate in the industry.
Engaged exclusively with self-funded employers.
Proven statistical methods used to identify areas of focus that vary from customer to customer.
The process of working with SmartLight Analytics was easy for us.
We are extremely happy with the results. They identified claims with waste and fraud, researched and recovered those costs and had it credited back to us. “
– Mike Adams, Dean Foods Vice President, Benefits & HR Systems
READ OUR WHITE PAPER ON THE EXPANDING COST AND RESPONSIBILITIES ASSOCIATED WITH EMPLOYER-SPONSORED HEALTHCARE