The challenge of balancing speed, accuracy, and trust
State Health and Human Services agencies face increasing pressure in management of Medicare, Medicaid and other healthcare programs. From determining and monitoring income conditions for benefits eligibility, to ensuring legitimacy of expenses and payments, those administering healthcare funds need to make accurate decisions at scale. In doing so, they strive to ensure trust in their decision-making, but compromises can mar their ability to truly understand who or what to trust.
This persistent tension between the speed at which a decision can be made and the rigor required to eliminate threats to an organization’s ecosystem, is further complicated by high caseloads, staff shortages, and fragmented data systems. This ultimately leads to delays, inconsistent outcomes, payment error rates above acceptable thresholds, and diverting or reducing dollars that could otherwise be spent to safeguard the health and welfare of program enrollees.
Accurately validate existing data and illuminate new risks faster than ever
Clearspeed’s technology is purpose built to solve for the tension between speed and accuracy. Our one-to-one, in-the-moment assessment of trust unlocks a new way to understand potential risk in real-time. Clearspeed provides a unique measure of human risk that enables better, faster decision- making, and remedies the tradeoff between speed and security.
Field-validated and scientifically-backed, our voice-based risk assessment analyzes the responses to a short set of customized and automated yes/no questions for universal vocal characteristics known to be associated with risk. This delivers a point-in-time, individualized trust assessment for each participant. Trusted individuals and transactions can be fast-tracked with confidence, while potential risks trigger additional scrutiny.
Clearspeed’s technology requires no additional data beyond the voice response. It is also language-, dialect-, and accent-agnostic, allowing for easy use across diverse populations. Clearspeed is a proven precision risk detection technology, deployed in commercial, defense, and intelligence communities across 37 countries and 60+ languages.
- Income and asset verification
- Enrollment status confirmation
- Duplicate enrollment detection
- Eligibility redetermination support
- Medical necessity validation
- Supplier legitimacy screening
- Prescription authenticity checks
- Repeat billing detection
- Upcoding and unbundling detection
- Services not rendered verification
- Provider identity confirmation
- Claim submission integrity check
- Medically unnecessary procedure flagging
- Pattern of care anomaly detection
- Referral legitimacy screening
- Treatment frequency validation
- UDuplicate payment identification
- Contractor compliance screening
- Vendor payment verification
- Federal-state cost sharing integrity
Clearspeed supports many law enforcement and security recruiting needs:
Fully automated for scalable, real‑time delivery
Point-in-time indicators specific to the individual
Language agnostic and globally deployed
Easy insertion into existing workflows
The Clearspeed voice-based risk assessment process starts with participants being presented with the questionnaire on any voice-enabled device. Clearspeed analyzes the participant’s vocal response to the case-specific question set, quickly identifying and scoring indicators associated with risk. This point-in-time, individualized risk assessment is then sent to the Medicare Administrative Contractors (MACs) or Recovery Audit Contractors (RACs) handling the transaction via API or available with the Clearspeed web app. This insight is used to inform next steps in transaction pathing.
Clearspeed Benefits
• Get faster, more accurate determinations: Improved risk assessments for automated eligibility and guided routing reduce processing time.
• Boost equity and reliability: Objective and unbiased assessments ensure consistent, fair outcomes across populations.
• Enhance program integrity: Illuminated risks in standard, redetermination, and presumptive workflows, identifying discrepancies early, reducing improper payments and churn.
• Reduce investigation cycles for low-risk cases: Build trust in the process for genuine beneficiaries, while enabling CMS/States to protect the sanctity of processes and funding.
• Improve funding allocation consistency: Improved risk assessment and management across beneficiaries and vendors promotes ease of continued eligibility for federal-state cost sharing under modernization initiatives.
Request a customized demo to see how Clearspeed can help accelerate trust across your program.
Learn more at www.clearspeed.com
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