---
title: "Clinical Claims Surveillance & Payment Integrity | Avandé"
url: "https://avande.net/what-we-do/clinical-surveillance"
description: "Every claim scanned daily, outliers flagged and reviewed by physicians before action. Stop inappropriate payment patterns before they become major losses."
last_updated: 2026-10-09
---

ONGOING

# Clinical Surveillance Continuous, physician-overseen claims monitoring

Catch harmful patterns before they become major losses.

- Health plans & TPAs
- Employers
- Stop-loss & reinsurance

[Discuss surveillance](https://avande.net/contact) 62% GENERATE SAVINGS

## 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

1. Losses stopped early EVERY CLAIM, EVERY DAY
2. Better provider behavior UP TO 70% FEWER TESTS BILLED
3. Action only on real problems PHYSICIAN REVIEW OF EVERY FLAG

### WHAT WE FLAG

- Recurring overutilization
- Inappropriate billing
- Clinical outliers

HOW IT WORKS

## Four steps. One standard.

1. Live

    ### Step 01: Scan every claim daily

2. Flagged

    ### Step 02: Flag outliers

3. In review

    ### Step 03: Physician review

4. 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

CASE STUDY · CS-03

### Excessive lab testing

400+ claims, nearly $500K. Payment stopped.

70% Fewer tests billed since

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 compared with Avandé
| PERIODIC AUDIT | AVANDÉ |
| --- | --- |
| Quarterly or annual | Every claim, every day |
| Looks back | Looks ahead |
| Losses already paid | Stopped before payment |

FAQ

## Straight answers.

### How is this different from an audit?

Audits look back periodically. Surveillance scans every claim daily and stops problems early.

### Who reviews the flags?

Board-certified physicians review every flag before any action.

### What does it save?

62% of claims selected for deeper review generate savings.

### Do we need new systems?

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.

[Let's Talk](https://avande.net/contact) or call **1-833-328-2633**

## More ways we help

- PRE-SERVICE

    ### Care Assurance

    Explore

    [Care Assurance](https://avande.net/what-we-do/care-assurance)

- POST-SERVICE

    ### Forensic Claims Validation

    Explore

    [Forensic Claims Validation](https://avande.net/what-we-do/forensic-claims-validation)

- TECHNOLOGY

    ### Healthcare IT Services

    Explore

    [Healthcare IT Services](https://avande.net/what-we-do/healthcare-it-services)