Alivia Analytics provides an AI-powered healthcare data analytics and technology platform, Alivia 360™, designed to help commercial and government health plans (including Medicaid and Medicare) reduce financial losses from fraud, waste, and abuse (FWA) and overpayments. The platform offers a unified solution for payment integrity across the entire claims lifecycle, from pre-payment prevention to post-payment recovery.
Key Capabilities and Features:
- Pre-Pay Preventive Analytics (FWA Claims Manager™): Flags high-risk claims and providers before payment using AI-powered edits, scoring, and configurable pend-and-review triggers. This helps to reduce improper payments and streamline early case review.
- Post-Pay Recovery Analytics (FWA Finder™): Utilizes AI-driven precision analytics and behavioral modeling to uncover hidden leads, billing anomalies, and non-compliant patterns that traditional rules-based systems often miss, particularly in the "Gray Zone" between error, waste, and fraud.
- SIU Case Management (Alivia Case Manager™): A centralized, scalable solution to track, manage, and accelerate the resolution of complex fraud cases and investigation workflows.
- Clinical Reviews & Audits: Offers both pre- and post-payment clinical reviews and audits by certified experts to validate medical necessity, coding accuracy, and compliance, with prebuilt audit workflows across areas like DRG and SNF.
- Data & IT Transformation (DataChrome™): Provides services to standardize and transform fragmented claims data into analytics-ready formats, modernize core claims platforms, and safeguard Protected Health Information (PHI), supporting systems like HealthRules and TriZetto Facets.
The solution is delivered as both a Software as a Service (SaaS) platform and Tech-Enabled Services, combining technology with deep claims expertise to deliver measurable results and increase operational efficiencies for payers of all sizes.