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Payer Solutions – Claims Analytics & Insights
Turn raw claims data into actionable intelligence to reduce costs, enhance quality, and drive payer performance.
Revix Health’s Claims Analytics & Insights solution empowers payers with the tools to unlock the full value of their claims data. By transforming millions of data points into meaningful patterns, we help identify cost drivers, predict risk, detect fraud, and optimize provider and member outcomes.
Built on AI-driven intelligence and deep healthcare expertise, our platform goes beyond reporting—delivering real-time visibility, proactive alerts, and strategic insights that help you make smarter decisions, faster.
How We Help Healthcare Payers
We turn claims complexity into clarity. With advanced analytics and expert interpretation, Revix Health helps payers optimize their networks, reduce medical loss ratios, and align with value-based goals.
Our Comprehensive Data Analytics Solutions
We offer an end-to-end analytics suite that transforms claims data into strategic value through intelligent automation, trend analysis, and actionable reporting.
Claims Data Aggregation & Normalization
Ensure a clean, unified foundation for insights. We ingest and standardize diverse claims data across systems and formats to build a consistent, analysis-ready repository.
What We Do
- Integrate claims from payers, TPAs, PBMs, and clearinghouses
- Cleanse, de-duplicate, and normalize structured/unstructured data
- Apply industry-standard and proprietary mapping for uniformity
Benefits
- Eliminate data silos and inconsistency
- Enable faster and more accurate analytics
- Improve operational efficiency in downstream processes
- Ensure regulatory data integrity and readiness
Claims Intelligence & Predictive Analytics
Turn data into insight with deep analytical models that track trends, flag anomalies, and project future utilization and risk.
What We Do
- Identify cost outliers, high-risk members, and inefficiencies
- Use ML algorithms to forecast claims volume, utilization, and spend
- Segment populations for stratified interventions
- Support medical loss ratio (MLR) and performance benchmarking
Benefits
- Reduce unnecessary utilization and costs
- Improve risk-adjusted planning and resource allocation
- Enhance population health and provider performance monitoring
- Strengthen underwriting, actuarial, and network strategies
Fraud, Waste & Abuse (FWA) Detection
Stop revenue leakage before it occurs. Our AI-enabled platform continuously scans claims for patterns of fraud, overuse, or billing anomalies.
What We Do
- Flag duplicate claims, upcoding, phantom billing, and suspicious behaviors
- Run predictive and rules-based analytics across all claim types
- Prioritize high-impact cases for audit or recovery
- Automate FWA workflows and alerts
Benefits
- Recover revenue lost to improper payments
- Reduce false positives and manual investigations
- Stay ahead of evolving fraud schemes
- Ensure compliance with regulatory guidelines and OIG frameworks
Our Comprehensive Data Analytics Solutions
We offer an end-to-end analytics suite that transforms claims data into strategic value through intelligent automation, trend analysis, and actionable reporting.
Claims Data Aggregation & Normalization
Ensure a clean, unified foundation for insights. We ingest and standardize diverse claims data across systems and formats to build a consistent, analysis-ready repository.
What We Do
- Integrate claims from payers, TPAs, PBMs, and clearinghouses
- Cleanse, de-duplicate, and normalize structured/unstructured data
- Apply industry-standard and proprietary mapping for uniformity
Benefits
- Eliminate data silos and inconsistency
- Enable faster and more accurate analytics
- Improve operational efficiency in downstream processes
- Ensure regulatory data integrity and readiness
Claims Intelligence & Predictive Analytics
Turn data into insight with deep analytical models that track trends, flag anomalies, and project future utilization and risk.
What We Do
- Identify cost outliers, high-risk members, and inefficiencies
- Use ML algorithms to forecast claims volume, utilization, and spend
- Segment populations for stratified interventions
- Support medical loss ratio (MLR) and performance benchmarking
Benefits
- Reduce unnecessary utilization and costs
- Improve risk-adjusted planning and resource allocation
- Enhance population health and provider performance monitoring
- Strengthen underwriting, actuarial, and network strategies
Fraud, Waste & Abuse (FWA) Detection
Stop revenue leakage before it occurs. Our AI-enabled platform continuously scans claims for patterns of fraud, overuse, or billing anomalies.
What We Do
- Flag duplicate claims, upcoding, phantom billing, and suspicious behaviors
- Run predictive and rules-based analytics across all claim types
- Prioritize high-impact cases for audit or recovery
- Automate FWA workflows and alerts
Benefits
- Recover revenue lost to improper payments
- Reduce false positives and manual investigations
- Stay ahead of evolving fraud schemes
- Ensure compliance with regulatory guidelines and OIG frameworks
Our Client Stories
Why Revix Health is the Top Provider for Claims Analytics
Smart Claims Engine: Our proprietary platform cleans, and accurately analyzes at scale.
Predictive Intelligence: Go beyond dashboards with forecasting models and proactive alerts.
Integrated FWA Tools: Built-in capabilities to identify and act on suspicious activity.
Compliance-Ready Reporting: Fully aligned with CMS, HHS, and state-specific requirements.
Latest Insights / Dive Deeper
FAQs
We work with medical, pharmacy, dental, and behavioral health claims from multiple sources, including TPAs, PBMs, and EMRs.
We use robust ETL pipelines, automated validations, and healthcare-specific normalization to ensure data is clean, consistent, and ready for analysis.
Yes, we offer integrated FWA detection that uses both rule-based logic and machine learning to flag anomalies, patterns, and high-risk claims.
Absolutely. Our models forecast utilization, costs, risk scores, and help stratify members for targeted intervention.
We follow HIPAA-compliant protocols, employ end-to-end encryption, and adhere to strict access controls and audit trails.
Yes. Whether you’re a regional plan or national payer, our platform scales to handle millions of claims with high performance.
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