Karthik Govindan | Chief Product & Transformation Officer
Integr8 AI™ Helps Small Payers Generate Big FWA Savings
Karthik has vast experience in healthcare billing including provider, payer, ambulance, medical device, pharmacy, and revenue cycle management. He has successfully developed and managed healthcare payment and technology solutions for payers and health systems. This work includes developing and deploying artificial intelligence and robotic process automation technologies and supporting services models. Karthik holds both a Master of Business Administration and Bachelor of Science degrees.
Small healthcare payers, especially TPAs and self-funded employers, often operate at a disadvantage when it comes to fraud, waste, and abuse (FWA) detection and prevention. Douglass Farquhar, Chief Strategy Officer at Reliant Health, described it this way during a symposium at the 2023 NHCAA Conference in Dallas, TX. He said:
“A few claims can have a big impact on a small payer. The goal for small payers is to detect more FWA pre-payment in real-time when savings are greatest. But the dilemma is that big payers can afford multiple technology layers to combat FWA; small payers cannot.”
That is where the power of patented, cloud based Integr8 AI technology and the 4L FWA Prevention solution come into play. In a study of small TPAs, pre-payment FWA detection and prevention after existing bill review processes reduced total claims paid by a minimum of 11% and up to over 20% immediately after implementing the 4L Advanced CMS Edits. These edits are one of four levels of edits powered by patented Integr8 AI technology.
For small payers implementing the Integr8 AI powered 4L FWA Prevention solution on top of existing bill review and editing processes, the immediate ROIs range from 29:1 to over 80:1. This means more savings for employers, lower healthcare costs for employees, and a better bottom line for everyone.
