Healthcare
AEGIS ISD
Healthcare Fraud Detection & Program Integrity Platform
- Category
- Healthcare
- Stage
- Growth
- For
- Medicaid, Medicare, and commercial health plan program integrity teams, including SIUs, medical review teams, and compliance officers.
About
Healthcare program integrity platform for fraud, waste, and abuse detection with SIU case management, medical review, pre-pay intelligence, and AI-powered investigation tools.
Features
- Problem
- High-value fraud signals can be buried in large alert volumes.
- How it works
- Detect applies configurable rules, risk scoring, routing, detection runs, and link analysis to prioritize alerts.
- Result
- Teams can focus investigators on high-priority alerts and hand qualified alerts to Core with evidence and rule context preserved.
- Why
- Analysts need transparent, operationally actionable triage before payment or investigation escalation.
- Problem
- Investigation evidence and decisions are scattered across systems.
- How it works
- Core centralizes leads, cases, activities, allegations, communications, determinations, corrective actions, and immutable timelines.
- Result
- SIU teams can manage cases from intake through defensible outcomes in one workspace.
- Why
- A single case record reduces manual handoffs and retains investigation context.
- Problem
- Clinical review requires structured collaboration and documentation.
- How it works
- Medical Review supports peer verification, medical-necessity decisions, documentation requests, QA workflows, and case-stage synchronization.
- Result
- Medical review teams can coordinate reviews with auditable, structured records.
- Why
- Clinical determinations need consistent processes and evidence.
- Problem
- Claims and external data require repeated custom ingestion work.
- How it works
- DataBridge connects claims feeds, files, databases, and API endpoints through visual mapping, validation rules, pipeline replay, and lakehouse publishing.
- Result
- Data operations teams can load, validate, and publish data for downstream detection and reporting.
- Why
- Teams need analysis-ready, governed datasets without one-off ingestion processes.
- Problem
- Documents can lose context, version history, and access control.
- How it works
- Drive provides case-linked folders, immutable version history, granular permissions, record links, extraction, and evidence-linked AI summaries.
- Result
- Investigators can keep documents connected to records while preserving access and audit history.
- Why
- Regulated investigations require traceable evidence management.
- Problem
- Investigators need AI assistance without sacrificing oversight.
- How it works
- AEGIS AI uses active screen context to provide evidence-linked answers and recommended actions, governed by five trust levels and audit logging.
- Result
- Teams receive contextual decision support while retaining role-based controls and investigation accountability.
- Why
- Program integrity decisions require human review, source traceability, and configurable autonomy.
Product questions
What does AEGIS ISD do?
AEGIS ISD is a unified healthcare program integrity platform for Medicaid, Medicare, and commercial health plans. It combines pre-pay claims intelligence, fraud detection, SIU case management, medical review, document evidence, and recovery tracking in an audit-ready workspace.
Who is AEGIS ISD for?
Medicaid, Medicare, and commercial health plan program integrity teams, including SIUs, medical review teams, and compliance officers.
Screenshots
