Preemptive Fraud, Waste and Abuse Defense for Home Health & Personal Care Services
Ensuring integrity and accuracy in specialized, high-volume healthcare areas
Payment integrity overview
Home health & personal care claims
Prebill dollars flagged
$34.2M$34,223,152
366K365,737 claims +4.1%
Prepay dollars flagged
$100.4M$100,390,632
1.03M1,031,004 claims +12.6%
Postpay dollars flagged
$13.9M$13,946,741
73K72,872 claims +2.3%
Dollars flagged per week ($M)
Top edits by dollars flagged
- Unreasonable outlier $85.5M
- Impossible day $34.2M
- Location conflict $14.9M
- Excluded provider $13.9M
Open cases
4 of 128
| Case | Provider ID | Flag | Status | Paid |
|---|---|---|---|---|
| CS-15017 | 1003878539 | Outlier | In audit | $773,228 |
| CS-15012 | 1023168382 | Rule | Active | $698,248 |
| CS-14998 | 1790183895 | Outlier | Active | $592,009 |
| CS-14971 | 1548263077 | Model | Recovered | $411,560 |
Total fraud, waste and abuse identified for our clients
- $600 Million
- Home Health & Personal Care
The platform
Everything your payment integrity team needs
Real time payor dashboard for analytics
Precise pre-pay claim flagging using our AI models and analytics visible on a dashboard.
AI enhanced expert claim audit
Results up to 70% faster with claim review by expert clinicians, coders and subject matter experts using AI to deliver results.
Products
Built for home care claims
Markets
Serving clients in the US & Canada
Resources
Latest from CareShield AI
Contact our team to explore your savings opportunities
Have your questions answered and get acquainted with our products.
- Learn how to increase payment accuracy and lower healthcare expenditure
- Explore use cases for your payment integrity team
- Get any questions answered about our products
Email us at sales@careshieldai.com or reach out on LinkedIn.
Payers have identified $600 million in fraud, waste and abuse for home health and personal care using CareShield AI.