Our Solutions
Smartchoice FWA Management
Your Partner in Combating Fraud, Waste & Abuse
Healthcare fraud, waste, and abuse (FWA) cost the industry billions annually—draining resources, inflating premiums, and undermining trust. At Smartchoice Technology, we partner with PLEXIS Healthcare Systems to deliver a cutting-edge FWA Management Solution that safeguards payment integrity, enhances efficiency, and protects your bottom line.
Seamlessly integrating with PLEXIS’ core platforms, our solution empowers healthcare administrators with real-time and batch-processing capabilities, ensuring fraudulent claims are identified—and stopped—before payment.
Why Choose the PLEXIS FWA Management Solution?
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- Automated Claim Editing
Powered by an extensive rule repository and AI-driven algorithms, our system flags inaccuracies, suspicious billing patterns, and potential fraud—minimising errors, denials, and financial losses. - Cost Containment Made Simple
By identifying and addressing FWA, administrators and medical schemes can achieve significant savings, reduce manual interventions, and meet cost containment objectives. - Smarter Automation
The solution streamlines workflows through efficient FWA detection, automated calculations, and processing of scheme-specific tariff fees, leading to increased auto-adjudication rates and payment accuracy. - Actionable Fraud Intelligence
Advanced analytics uncover emerging fraud trends, giving you the insights needed to stay ahead of risks and refine your prevention strategies. - Scalable, End-to-End Workflows
The solution's powerful Electronic Data Interchange (EDI) hub delivers enterprise-wide efficiencies with end-to-end workflows for claims and encounter data, supporting scalability to meet the needs of various healthcare organisations.
Implementing the PLEXIS FWA Management Solution empowers healthcare organisations to proactively manage risks, maintain compliance, and optimize their claims processing operations. By leveraging this robust platform, payers can enhance transparency, accountability, and overall efficiency in their healthcare delivery systems.
Strengthen Payment Integrity & Reduce Financial Risk
Our FWA solution provides healthcare insurers with sophisticated tools to enhance payment integrity by:
- Cut claim errors – AI-powered editing and analytics minimise costly mistakes.
- Lower unnecessary expenses – Stop fraud before it impacts your budget.
- Optimise operations – Automate manual tasks for faster, leaner processes.
With an intuitive interface, administrators gain deeper visibility into claims data—enabling smarter decisions, stronger compliance, and improved financial performance.
Fully Customisable to Fit Your Needs
Our Fraud, Waste, and Abuse (FWA) solution is designed with adaptability in mind, offering extensive customisation to meet the unique requirements of each insurer. By leveraging a comprehensive rule repository, advanced algorithms, and closed-loop analysis capabilities, our solution enables:
- Tailored configurations: Adjust rules and workflows to match your unique requirements.
- Maximum impact: Optimise detection accuracy while reducing false positives.
- Simplified administration: Minimise manual reviews and free up resources.
The FWA solution also empowers healthcare funders to streamline their claims processing operations and improve their bottom line. It not only reduces the rate of FWA but also provides funders with actionable insights that allow them to take proactive measures to prevent FWA from occurring in the future. With SCT's powerful analytics tools, funders can perform real-time analysis and make data-driven decisions.
The FWA solution is designed to help healthcare funders improve their bottom line by reducing the cost and impact of FWA. By leveraging its extensive rule repository, advanced algorithms, and real-time analytics capabilities, funders can reduce their FWA rates, increase the accuracy of their claims processing, and maintain compliance with industry regulations.
With our comprehensive FWA solution, healthcare funders can combat fraud, waste, and abuse in their organisation. The solution is designed to be user-friendly, flexible, and highly configurable, enabling funders to streamline their operations and improve their bottom line.
By leveraging its powerful payment integrity solutions and analytics tools, funders can reduce their FWA rates and increase the accuracy of their claims processing while maintaining regulatory compliance.