PADRE

EagleForce Associates has licenced a patent pending claims/benefits Business Activity Monitiorning (BAM) and Paperless Automatic Adjucication, Denial and Re-Classification (PADRE℠) claims processing system, which utilizes a combination of rules-based analysis, algorithm and statistical based technology, and methods to perform pre-payment predictive analytics and modeling to both identify Fraud Waste and Abuse and to determine the efficacy of medical claims.  Additionally, PADRE℠ examines content from historical claims and organizational data along with comercial data to establish relivant data and to accurately adjudicate medical coding and claims.  PADRE℠ is further designed to statically track patient outcomes. The system software is scaled to process well over 1.2 billion claims each year, submitted from more than a million health care and equipment providers whose PADRE℠ Profile extends 12 times more extensive than the standard CMS profile through the use of current commercial data.  Processing is "Cloud Capable" and takes place on an integrated platform whose mission specifically targets accurate claims adjudication (validation of claims and detection of fraud, waste, and abuse), reduction of paper, and elimination of human intervention. The system has been demonstrated on actual CMS controlled data, having processed Part A and B data for all claim types.


The PADRE℠ software platform is designed to reduce the complexity associated with servicing the complex Fee –for- Service (FFS) enterprise which is made up of numerous payment systems and meets all Federal Standards for processing and information security. PADRE℠ is effectively able to adjudicate large volumes of coded transactional data along with queries from pre-processed claims. The enterprise system delivers “Accept/Approve, Deny, or Re-Classify” signatures to the associated record in a paperless automated fashion, thereby allowing the management and monitoring of the decision making process to become completely seamless and equally administered without bias to claim size.  The system uses an Artificial Intelligence “Feedback Loop” to “Learn” from manually processed and adjudicated claims. 


For more information, contact us at BigDataInsights@theeagleforce.net or call 855-481-2110.

Our mission is to assist our clients in the design and deployment of intelligent systems where man and machine interface and applications are designed to optimize the performance of each by providing the heavy lifting for many of the most difficult problems in computer science.

Contact Us

BigDataInsights@theeagleforce.net
855-481-2110

Location

13241 Woodland Park Road, Suite 600
Herndon, VA 20171