Theja Birur, CTOIf there is one thing ThejaBirur, the CTO of APATICS, Inc., big data health care predictive analytics firm, remembers from her IT career in the Canadian and U.S. healthcare industry, was the industry is extremely slow to adopt novel technologies. “Especially for health insurance and workers’ compensation sector, the situation was worse and I wanted to break the status-quo by bringing technology and introduce a platform to better understand every medical provider in the US based on billing, quality and other outcomes trends” she says. Through APATICS, Theja is transforming her vision into a significant reality. The company specializes in extracting valuable care insights from healthcare data through its platform product, FraudLinx. The automated platform mines up to 270 data points to extract intelligence and assist healthcare institutions in areas including provider care metrics, drug abuse, patient care and associated costs. APATICS provides a unified 360° view of providers by gathering and summarizing information from both internal and external systems. As a result, APATICS delivers significant key actionable insights regarding provider performance, risk and cost to help their clients with smarter care decisions. FWA defined as fraud, waste and abuse is costing the US health care government alone over $700 Billion annually and growing. This is now a global problem facing many countries.
FraudLinx utilizes pre-built machine learning and predictive analytics algorithms to trigger red flags on medical bills, external alerts, lawsuits, arrests and license infractions. Theja elaborates, “Our platform brings many different aspects to identify care provider information and fraud in the healthcare insurance industry to a singular and comprehensive system.” Delivered as a SaaS model, FraudLinx does not require any infrastructure or human prerequisites and expertise to get started.“All we need is the clients’ provider and claims data that will be fed into the platform to extract intelligence about the provider, drug abuse or associated costs,” mentions Theja.
Being a vendor agnostic company, allows APATICS to implement FraudLinx on any Hadoop open source or enterprise software. APATICS can integrate with external systems using prebuilt connectors to unstructured text, databases, flat files, APIs, Web Services and ETL which results in seamless data-driven delivered actionable insights. FraudLinx can connect to any BI tools to create dashboards, reports and integrate with any PMML model for predictive modeling; the platform can process huge amounts of data and index them either in batch or real time. The offering is also fully HIPAA and PCI compliant.
Our platform, FraudLinx is unique as it brings many different aspects to identify care provider information and fraud in the healthcare insurance industry to a singular and comprehensive system
With such robust functionalities, clients can easily drill down to red flag bills, alerts, ranking, and reports to collect evidence which in legacy approach would take weeks and months to obtain. In an instance, APATICS analyzed a small portion of an existing national, credentialed PPO. By only analyzing the NPI numbers, FraudLinx identified more than 20 percent of their existing approved providers with red flags. This insight enabled the client to exclude further utilization of the flagged providers and improve quantification of their network which would reduce risk, improve outcomes and increase overall savings. This is APATICS’ vision to help clients reduce their FWA exposure and bend costs curves with high value, AI enabled insight.
Enabling the company to achieve several such success stories, APATICS’ core team comprises of healthcare IT veterans and advisers, along with some of the world’s leading data scientists. APATICS co-founders ThejaBirur and DimitriArges hold significant health care industry knowledge which translates their expertise into APATICS’ service delivery model. Looking ahead, APATICS is continually striving to sharpen the edge of its offering.
Theja concludes, “When I started the company over two years ago, I wanted to build a provider database. Going forward, we want to become the aggregator of provider intelligence for insurance companies across America and use latest technology that can enable this vision.
Theja finishes this interview saying our product is FWA interrupted!!.