CASE STUDY · CS-03
Excessive lab testing
400+ claims, nearly $500K. Payment stopped.
70%Fewer tests billed since
ONGOING
Clinical SurveillanceContinuous, physician-overseen claims monitoring
Catch harmful patterns before they become major losses.
- Health plans & TPAs
- Employers
- Stop-loss & reinsurance
Discuss surveillance62% GENERATE SAVINGS
FLAGGED OUTLIERSLIVE
- PRV-2281 · IMAGING VOLUMEFlagged
- PRV-1904 · REPEAT CODESFlagged
- PRV-3317 · LENGTH OF STAYIn review
- PRV-0752 · BILLING PATTERNFlagged
The problem
Thousands of small inappropriate payments can hurt as much as one catastrophic claim.
Periodic audits find them only after they’re paid.
Overview
What we do.
Clinical Surveillance is Avandé’s continuous claims monitoring. Every claim is scanned daily, outliers are flagged, and physicians review each flag before action, catching patterns periodic audits miss.
Key benefits
- Losses stopped earlyEVERY CLAIM, EVERY DAY
- Better provider behaviorUP TO 70% FEWER TESTS BILLED
- Action only on real problemsPHYSICIAN REVIEW OF EVERY FLAG
WHAT WE FLAG
- Recurring overutilization
- Inappropriate billing
- Clinical outliers
HOW IT WORKS
Four steps. One standard.
- Live
Step 01: Scan every claim daily
- Flagged
Step 02: Flag outliers
- In review
Step 03: Physician review
- Determined
Step 04: Act and report
EVERY STEP RUNS ON ANSERA PORTAL
Results
Measured, not promised.
100%Of claims scanned daily
0.5%Selected for deeper review
62%Of selected claims generate savings
Why Avandé
Daily, not quarterly.
Problems are caught as they start, not months later in an audit.
- SOC 2 Type II
- HIPAA
- BAA
- PHI Protection
| PERIODIC AUDIT | AVANDÉ |
|---|---|
| Quarterly or annual | Every claim, every day |
| Looks back | Looks ahead |
| Losses already paid | Stopped before payment |
FAQ
Straight answers.
Audits look back periodically. Surveillance scans every claim daily and stops problems early.
Board-certified physicians review every flag before any action.
62% of claims selected for deeper review generate savings.
No. We connect to your claims data through FHIR, X12 EDI or API.
Talk to a physician-led team
Discuss surveillance.
A few sentences are enough.