FRAUD PREVENTION

Payment Protector™

An advanced Pre-Payment Fraud Prevention System.

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FRAUD DETECTION

Intelligent Investigator™

A powerful Fraud Detection System built for investigative teams.

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FRAUD RECOVERY

Trail Tracker™

A comprehensive fraud, waste and abuse Case Tracking Management and Recovery System.

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FRAUD SERVICES

Virtual SIU™

Scalable Special Investigations Unit (SIU) services designed to empower every client.

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EDIWatch Inc., a privately held corporation since 1999, is a leading provider of anti-fraud, waste and abuse (FWA) information technology solutions exclusively for the healthcare payor industry. For more than a decade, EDIWatch has delivered leading-edge products and services that support every facet of FWA prevention, detection, and recovery.

 

Anti-Fraud, Waste, and Abuse Solutions for Healthcare Payors

 

EDIWatch empowers healthcare payors with the most comprehensive anti-fraud solutions available through:

  • Superior Products. EDIWatch offers the industry's only end-to-end, fully integrated suite of healthcare insurance fraud prevention, detection and recovery products and services on the market.
  • Innovation. EDIWatch delivers innovative solutions that permit special investigator units to act without IT/data analysis support. Enabling these diverse experts, including investigators, coders, nurses and law enforcement agents, is paramount to the success of any anti-fraud initiative.
  • Continuous Reinvestment. EDIWatch continually reinvests in their comprehensive knowledgebase, giving them a competitive edge that effectively aids in efforts to identify and thwart new medical insurance fraud schemes.

 

EDIWatch's advanced suite of healthcare insurance anti-fraud, waste and abuse products are driven by two enabling technology platforms:

  • Rules-Based Inference Engines
  • Predictive Modeling Engines

 

Each of these has been customized to work specifically within a prepayment and post-payment environment. These highly engineered platforms have been optimized to pinpoint patterns of suspicious behavior across all healthcare claim types, including fraudulent:

 

    1. Medicare Claims
    2. Medicaid Claims
    3. Medical Claims
    4. Facility Claims
    5. Pharmaceutical Claims
    6. Dental Claims

 

This fully integrated anti-fraud offering includes:

 

Pre-Payment Platforms:

  • PreSPOT™ pre-payment rules-based inference engine
  • PrePATE™ pre-payment predictive analytics technology engine

 

Post-Payment Platforms:

  • SPOT™ rules-based inference engine
  • PATE™ predictive analytics technology engine

 

Integrated Suite of Products:

  • Payment Protector™ pre-payment fraud prevention system
  • Intelligent Investigator™ fraud detection system
  • Trail Tracker™ fraud, waste and abuse case tracking management and recovery system

 

Unparalleled Special Investigative Unit (SIU) Support Services:

  • Advanced Analytics Unit™ data analytics intelligence
  • Virtual SIU™ scalable investigative services
  • Fraud Forum™ customizable education & training

 

EDIWatch's unsurpassed technology offerings guarantee enhanced staff productivity, actionable intelligence and comprehensive pattern recognition for FWA activity identification.
 
Prepayment Claims | Post-Payment Claims | Predictive Modeling Engine | Rules-Based Engine
Fraud Prevention | Fraud Detection | Fraud Recovery | SIU Services | SIU Outsourcing