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Surface and prioritize nonpayables
to complete more reviews, faster.

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Watch 5-minute CAVO Predict demo

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Getting started with health plan payment integrity review automation

CAVO Predict’s algorithms review and recommend prioritization of denied charges – and detail reasons for flagged charges. Claim reviewers easily accept or reject each suggestion, and CAVO Predict utilizes these decisions to continuously refine the machine learning model for that health plan’s reviews. Leverage CAVO Predict to streamline claims review processes, and to begin or enhance health plan payment integrity automation initiatives.

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3 BENEFITS OF CAVO PREDICT

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Positively impact health plan financials

Proactively identify often missed, high-frequency charges
Move providers to prepay claim reviews

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Increase payment integrity review productivity

Leverage your review team’s skillsets and time

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Continuously refine machine learning and NLP models

Enhance models with reviewers' ongoing decisions
Customize prediction rules with health plan policies and guidelines

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20 MINUTES

1:1 CAVO Predict Live Demo

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WHY CHOOSE CAVO PREDICT

Leverage Our Resource Trifecta for Machine Learning

Healthcare Data Science Expertise
Data scientists specializing in healthcare claims review models customize algorithms to your objectives

Our payment integrity vendor's machine learning resource differentiators

 Health Plan Claims Review-Specific Technology
CAVO enables continuous machine learning model refinement based on your ongoing review decisions

Claims Review
Clinical Expertise

Clinicians are the liaisons and SMEs to help build and initially test the machine learning model

Partner with one payment integrity vendor  Ι  Minimize plan review time investment

CAVO® Predict – Itemized Bill Reviews

  • Flags specific suspect “IB” or “iBill” charges

  • Utilizes algorithms customized to your organization’s review processes and guidelines

  • Highlights suspect charges for human review and decision determination, replacing exhaustive manual reviews

LET’S CHAT
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Itemized Bill Review NLP Example

In most cases, tubing is used for IVs and is reusable. However, when tubing is used as a feeding tube, it is only usable for a single patient. Using Natural Language Processing (NLP), CAVO Predict – Itemized Bill Reviews flags non-feeding tube charges for prioritized payer review and enables efficient decisions using our ibill review platform’s sort and filter features.