AI-Enabled Payment Integrity Data Solution

This document is a technical report that outlines the features and benefits of the AI-Enabled Payment Integrity Data Solution provided by Abacus Insights. It addresses the challenges faced by payment integrity programs due to evolving billing and reimbursement rules, complex care delivery, and improper payments that lead to medical cost leakage. The report details how the Abacus solution unifies various data sources, including claims, eligibility, provider contracts, and clinical records, into a single governed data foundation. This integration allows payment integrity teams to detect issues earlier, investigate faster, and respond with confidence. The document also highlights the solution's ability to support existing claims platforms and workflows, improve data flow, and enable advanced analytics and AI applications without the need for system replacement. Key capabilities include data quality governance, reusable data across use cases, and flexible distribution methods.