Data & Analytics


At Carewise Health, we offer a range of analytics to drive payment integrity and reduce costs.  We use a combination of the most experienced nurse clinicians to carry our Payment Integrity services. They are backed up by data and behavioral scientist, engineers and information technologist to ensure they are using the most reliable and valid data, and the most advanced technology.  

Carewise Health supplements our health care domain, clinical and scientific expertise with actuarial and financial expertise to ensure our products and services deliver transparent financial results to customers. Carewise Health has the experience to manage large and complex customers.

Analytics Engine of Payment Integrity

Called QEC (Quality, Efficacy, Cost) Analytics, these proprietary, predictive algorithms can be used to identify and target inappropriate claims and overpayments. Analysis created through the process, generates a road map to improved clinical and financial metrics and analytical insights. This leads to actions that prevent expenditures and reduce revenue leakage.

Carewise Health has access to one of the largest data repositories used in creating unique models and algorithms in support of our products and services. We blend clinical and health care data with non-traditional, non-health care data sets to improve predictability and applications of our models.

Payment Integrity Solution

  • Identify and recover inappropriate claims and overpayments
  • Identify the cases that should be subject to nurse audits or care management
  • Reduce the cost of the payment cycle
  • Avoid and prevent inappropriate claims and overpayments
  • Experienced nurse auditors work with providers and recover payments for clients
  • Nurses are trained and perform their duties professionally, preserving relationships with network providers
  • 99% success in obtaining signed audits