Detect fraud, waste, and abuse before payments are made
Novacis Digital FWA Payor Analytics evaluates claims in real time and identifies anomalies early. It drives action before payment, so teams prevent loss instead of recovering it.
Most FWA solutions identify issues after payment, when recovery is slow, expensive, and incomplete. Novacis Digital FWA Payor Analytics analyzes claims in real time, detects anomalous patterns, and moves cases forward before payment is authorized.
It understands claim data, identifies risk patterns, generates evidence, and triggers investigation workflows automatically. The result is reduced payment leakage, faster investigations, and a shift from recovery to prevention.
Deep pattern-based analysis beyond static rules
Analyzes patterns across claims, providers, and members
Connects detection to investigation and case execution
Delivers audit ready outcomes for every case
Reduced payment leakage
Faster investigation and resolution
Full claims coverage
Audit-ready case documentation
Who It's for
For teams responsible for payment integrity, risk control, and compliance
Payment Integrity Analysts
Focus on high risk claims with prioritized insights and supporting evidence.
Fraud Investigation Teams
Start with investigation ready cases instead of raw claim data.
Program Integrity Leaders
Monitor claims continuously and act before payment is released.
Finance and CFO Teams
Reduce avoidable losses by shifting from recovery to prevention.
Claims Operations and Medical Directors
Identify anomalies early with clear risk prioritization.
Compliance and Risk Leaders
Maintain full traceability across every investigation and outcome.
How it works?
From detection to resolution, Novacis Digital FWA Payor Analytics solution runs a continuous intelligence loop
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02
03
Detect
Analyzes incoming claims data in real time to detect anomalies across billing patterns, providers, and members.
Understand inputs and context
Capture claims data
Claims Streams
Provider Submissions
Member Data
Historical Claims
Batch Inputs
API Feeds
Supports
Multi-Payer Data
High-Volume Claims
Real-Time Streams
Structured Data
Unstructured Data
Secure Processing
Investigate
Builds evidence-backed cases using relationship mapping, risk scoring, and pattern analysis.
Detect anomalies
Pattern Recognition
Outlier Detection
Provider Analysis
Member Analysis
Billing Patterns
Risk Scoring
Build investigation context
Case Creation
Relationship Mapping
Evidence Generation
Trend Analysis
Alerts
Prioritization
Act
Routes cases into workflows for investigation, recovery, and closure before or after payment.
Enable investigation workflows
Case Routing
Workflow Assignment
Evidence Tracking
Investigator Tools
Case Updates
Collaboration
Drive resolution actions
Payment Holds
Recovery Actions
Escalations
Reporting
Compliance Tracking
Audit Logs
Built to detect, investigate, and act on FWA risks
Every capability in Novacis Digital FWA Payor Analytics is designed to detect, investigate, and resolve FWA at scale.
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