SAN
JOSE, Calif., Aug. 15,
2024 /PRNewswire/ -- Planned Administrators, Inc.
(PAI) is partnering with Health at Scale to identify inappropriate
healthcare claims before they are paid. Through the partnership,
PAI will use Health at Scale's breakthrough technology for
real-time screening of claims in a pre-payment setting, to detect
inappropriate claims and surface them for review before the dollars
are paid out.
"Employers are working hard to fulfill their mandate of using
plan dollars wisely," said George Stiles, PAI President and
COO. "This deployment represents a big step forward in PAI's
ongoing commitment to help them fulfill their fiduciary duty and
provide employees with the best care at the lowest cost."
An estimated 25-30% of all US healthcare spend is estimated to
be lost to spending that is waste, abuse or fraud,
which equates to almost $1,700 per
member per year. This cost burden directly impacts the ability of
employers to continue providing high-quality, affordable health
benefits to their employees. Though the problem is widespread,
limited progress has been made by traditional payment integrity
systems with manually-crafted rules, which are subject to high
rates of false positives and false negatives. In contrast, Health
at Scale delivers industry-leading accuracy through smart,
context-aware and clinically-nuanced analysis of each claim in
real-time with a deep understanding of the patient, the provider,
the time and the setting of care.
In addition to saving crucial dollars for employers, the
technology will also play a role in improving employee well-being.
With the financial incentive to perform wasteful procedures
removed, fewer employees will receive care that is unnecessary, or
even cause harm or health complications.
"We are delighted to be part of PAI's leading solution for
employers," said Health at Scale CEO Zeeshan Syed. "Wasteful services are a burden
for employers and their members, and continue to propagate
healthcare inequity with employees and dependents in underserved
geographies or those challenged by social determinants of health
disproportionately impacted. We're excited to play a positive role
in helping reduce this burden."
Health at Scale's Precision Fraud, Waste, and Abuse
Detection™ is highly differentiated as the only solution
developed by a leading technology team with widespread recognition
for pioneering contributions to healthcare AI advances. Health at
Scale's technologies have been used for millions of lives in
pre-pay and post-pay settings, with proven results in deployments
for employers, third-party administrators and insurers.
About Health at Scale
Health at Scale uses advanced AI
to drive smart, hyper-personalized, context-aware care delivery and
management. Founded by machine learning and clinical faculty from
MIT, Harvard, Stanford and
the University of Michigan, the company
brings precision to healthcare across a broad range of use cases,
including: waste, abuse and fraud prevention,
reduction of medical and drug errors, provider navigation and
network curation, and early targeted prediction and prevention of
adverse outcomes. For more information, please visit
healthatscale.com.
About Planned Administrators, Inc.
PAI is a nationally
licensed TPA, delivering flexible solutions across group health
plans, ancillary products, and P&C programs, and offering
innovative approaches to support client partners. We currently
provide administrative services for both traditional self-funded
accounts, as well as providing business process outsourcing
solutions for regional and national businesses.
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SOURCE Health at Scale Corporation