Building A.I. Into Your ERP Planning and Implementation

Building A.I. Into Your ERP Planning and Implementation

During this pandemic, companies, like so many of us in our personal lives, have faced unexpected and unusual challenges.  Not only because of the virus. but also due to the resulting economic upheaval and uncertainty. Healthcare has been at the forefront of our lives, all over the news.  Regrettably, fraud within the healthcare system has become a major focus of criminals.

Healthcare fraud has skyrocketed. This situation has accelerated the trend by corporations to enhance their ERP, (Enterprise Resource Planning), and implementation.  ERP applications can offer software as a service (SaaS). A complete suite of ERP applications forms an ERP system that can effectively communicate and aggregate business processes.  This enables a flow of data between the applications and databases either on-site or through cloud solutions.  ERP implementation has been crucial as so many of us are working from home.

A profound development in the sprint to modernize ERP is the adoption of Artificial Intelligence for use in the detection of healthcare fraud, as well as banking, anomalies in business contracts, and procurement (and much more).  AI provides real-time data collection, analysis and forecasting.

Why Is Real-Time Risk Analysis Important to Detect Healthcare Fraud?

 AI driven real-time risk analysis and management enables compliance and fraud teams to identify fraud in real-time and act on it before it’s too late.

According to the US based Coalition Against Insurance Fraud “tens of billions of dollars are stolen each year by fraudulent means in healthcare.”1  Investment into Healthcare Fraud analytics will increase from $1.2 Billion in 2020 to $6.2 Billion by 2027 due to the dramatic increase in healthcare fraud.2  Because of the pandemic, healthcare fraud costs are quickly increasing for insurance companies.

A major area of healthcare fraud is upcoding or overbilling on already expensive in-patient Hospital stays for COVID-19, as well as a plethora of other scams and cybercrime, such as:

  • Pharmaceutical Fraud – off label, kickbacks, adulterated products
  • Medicaid rebate fraud
  • Overprescribing or unnecessary prescribing
  • Falsified Diagnoses
  • Ambulance Fraud
  • Unreasonable costs of medicine and services
  • Billing for services not rendered or services not offered
  • Home healthcare fraud

The Most Advanced Healthcare Fraud AI

Real-time risk management enables you to identify fraud as it’s happening, to prevent making payouts on fraudulent activities. Thus, to protect your business it is vital to have the optimal AI software.  You need to incorporate AI into all of your ERP planning and implementation.

The world’s most advanced Transactional AI software is created by ToolCASE. We offer a suite of products that serve health insurance organizations, hospitals and medical practices as well as banking, financial and credit institutions.  All of which bear the brunt of the of healthcare fraud.

The solution for healthcare fraud is in ToolCASE’s proprietary RembrandtAi and Informant functionality, its real-time analytics capability, data aggregation from multiple sources and presentation of data through visualization and alerts.

The ToolCASE AI suite implementation can take place within days or weeks, not years.  The installation and employee training are quick, seamless and intuitive. Companies using the ToolCASE suite of software featuring Rembrandt AI and Informant can anticipate and resolve customer queries, accelerate prior authorizations, review claims, manage memberships and billing and deliver quality improvement and maintain regulatory compliance via automated reporting and regulatory updates.  ToolCASE does it all.  And allows your compliance or fraud department to operate at exceptional efficiencies.

Additional benefits include risk and compliance management for financial institutions such as insurance companies.  This includes internal audit and cybersecurity capabilities. Transaction, balance and intentions trend and pattern analysis are presented in Data Visualization and Alert formats. RembrandtAi integrates with online and mobile banking and other self-service systems for Opt-in and Automatic Consumer Alerting.

The optimal AI driven breakthrough is finally here for Health Insurance Organizations.  With the implementation of the ToolCASE suite of AI products into your ERP, you have an effective “war-room” defense at your fingertips.

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