Control of Claims

The process begins with the company's Advanced Warning and Containment® (AWAC®) software.

AWAC® is built around a database of more than 60,000 physician-produced algorithms, tens of thousands of actual cases, and millions of claims. The program is the first and only electronic claims surveillance system of its kind in existence. It securely downloads and scans clients' claims data, prescriptions, and pre-certification records every night. By comparing this information with the information in more than 50 separate databases, the program identifies cases that are likely to become catastrophic — sometimes from a claim as small as $30. It also infers outcomes and recommends possible actions. Physicians then review the cases. The program identifies and does custom reviews based on its knowledge of insureds or providers. This all happens daily before the claims are paid.



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