Product
CareShield AI for Home Care
Capture more savings with prepay FWA edits, algorithms and analytics that go beyond electronic visit verification (EVV). Built for skilled home health and personal care services.
Outlier
Unlikely work consistency
Personal care and home health patients rarely have stable schedules due to inpatient stays and extra services required.
- Category
- Logistical
- Provider specialties
- Home Health Aide, Hospice Aide
- Data required
- Personal CareHome HealthAll ClaimsEVV
Claims flagged
72,165
Dollars flagged
$13.9M$13,879,489
Case audit summary
Flagged dollars broken down by their confirmation status
$6,800,949.61 49%
$5,829,385.38 42%
$1,249,154.01 9%
Runtime
Pre-production
v2.0.0-2025-03-01
Production
v2.0.0-2025-03-01
Cases
Assigned ToStatusType| Case ID | Assigned to | Status | Type | Provider ID | Claims | Paid |
|---|---|---|---|---|---|---|
| 4d5c28e506d9a7fdbe8c9d3cbd1a9438fecadccf3cbac | Auditoria Crow | Active | Outlier | 1255706032 | 312 | $199,989 |
| e407fde01280a4de1c3db02c5dc2a7a73e5ccd181f38f6 | Auditoria Crow | Active | Outlier | 1467651026 | 1,129 | $196,390 |
| 9e23874bc5eed02a6ae04ac8f557dcedb7d59e1e40d4 | Auditoria Crow | Active | Outlier | 1265403208 | 403 | $191,489 |
| 2f70dabde24d73885fee1e3687d5b351a54efce76913b5 | Auditoria Crow | Active | Outlier | 1003070004 | 370 | $184,565 |
Configurable Claim Edits Ready for Deployment
Take advantage of our ever growing list of edits to capture FWA in both prepayment and postpayment environments. Our edits, rules and algorithms are constantly updated to match your specific policies and guidelines as well as those from public institutions such as CMS, AMA, Medicare and Medicaid.
Transparent Claim Flagging
View every flagged claim in our dashboard to see all details, including why it was flagged, which edit, algorithm, or model flagged the claim, which providers were involved, and which members were affected.
Find the most at risk providers with Provider ScoreCarding
Filter for the highest risk providers to target your education and audit resources. Our system continously updates provider scores allowing you to monitor the impact of educational interventions.
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.