Provider Billing Alerting
Reads each provider invoice line by line, cross-checks it against the agreement tariff and alerts with a zero to one hundred score on every deviation found.
THE CONTEXT
Auditing every invoice by hand simply fails at scale
An insurer pays thousands of provider invoices a month. Checking each line against the tariff by hand is unfeasible, so the team samples or pays blind. Overbilling and tariff deviations slip through invoice after invoice and inflate the cost of claims with nobody noticing.
THE SOLUTION
A control that reviews one hundred percent of lines
The agent reads each provider invoice line by line, cross-checks each item against the agreement tariff and gives it a zero to one hundred score. Lines within tariff flow on their own and the ones that deviate get flagged. The team reviews only the anomalies.
KEY CAPABILITIES
What the control resolves on every invoice
Line-by-line reading
Reads each provider invoice with OCR and splits item, quantity and price line by line, with nobody capturing or reviewing it by hand.
Tariff cross-check
Compares each item against the live agreement tariff and spots the off-tariff price, the duplicate and the item that does not match.
Deviation score
Gives each line a zero to one hundred score by how far it deviates from the tariff, to split a minor error from overbilling worth a review.
Prioritized alert
Sends the alert for the deviating invoices to the team, sorted by score, so they hit the highest amount first and release the rest.
Before / After
Invoice auditing stops being a manual sample and covers one hundred percent.
Review by manual sampling
Tariff deviations slip through
Overbilling caught too late
System Integrations
Connects to what the resolution desk already uses
Reads invoices from the doc manager, cross-checks each line against the agreement tariff in the ERP and sends the deviation alerts to the payments board.
FAQs
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