Alivia Analytics Solutions

SOLVING COMPLEX CHALLENGES

We help health plans and government agencies address financial losses caused by FWA, errors, missed recoveries, fragmented data, and outdated processes.

Pre-Pay Preventive Analytics

Our FWA Claims Manager™ flags high-risk providers before payment using advanced scoring, configurable pend-and-review triggers, and built-in compliance checks—helping reduce improper payments and streamline early case review.

Post-Pay Recovery Analytics

Our FWA Finderâ„¢ uncovers hidden leads and accelerates SIU investigations, while Alivia Case Managerâ„¢ streamlines case volumes and workflows. Combined with Clinical Audits and Data Mining, we recover more from overlooked FWA and errors.

Innovative Data & IT Services

Our DataChromeâ„¢ standardizes claims data into analytics-ready formats and supports all ingestion needs. We also optimize and migrate Claims Systems and Safeguard PHI, advancing payer transformation with secure, scalable infrastructure.

All Alivia Solutions

Claims Data Ingestion & Integration

Our innovative DataChromeâ„¢ solution centralizes fragmented claims data and converts it into standardized, analytics-ready formats to improve reporting, FWA detection analytics, and payment integrity initiatives.

FWA Claims Manager™ − Pre-Payment Prevention of Healthcare Fraud

Stop high-risk providers at the source before payments are made, preventing financial impact and limiting resources…

Healthcare Claims Edit Engine

Validates claims as a primary, secondary, and/or post-payment editor backed by industry experts and advanced technology…

FWA Finder™ – Precision Analytics for Fraud Detection

Uncover hidden fraud risks and generate leads faster with AI-driven post-pay claims intelligence…

Alivia Case Manager™ – Streamlined Healthcare Fraud Case Management

Track, manage, and resolve complex fraud cases faster with a centralized, scalable post-pay case solution…

Comprehensive Clinical Audit Solutions

Ensure medical necessity and reduce overpayments with expert clinical audits across high-risk post-pay claims…

Data Mining Health Plan Solutions

Identify billing anomalies, duplicates, and trends with powerful post-pay analytics that uncover hidden errors…

SIU Services – Pursuit Beyond Fraud Detection

Augment your SIU team with expert investigators and coders to accelerate case resolution and recovery…

Healthcare Claim Systems Modernization

Optimize claims platforms like TriZetto Facets, QNXT, and HealthEdge HealthRules to improve performance and support evolving requirements, or extend the life of legacy platforms like AMISYS and Conduent HSP.

Legacy Platform Intelligence & Stabilization

LegacyIQâ„¢ provides intelligence into aging systems and code written decades ago, such as COBOL, RPG, Java, .NET/Visual Basic, C/C++. Stabilize critical platforms. Assess modernization paths. Move with confidence.

Healthcare Data De‑Identification

Safeguard patient privacy and support regulatory compliance with advanced data masking that protects PHI, enabling the safe use of healthcare data in non-production environments, including X12 EDI.