APPRAISE

The Ancillary Provider Profiling and Information System (APPRAISE) is an automated health insurance web application that determines the risk that individuals who transact with health funds commit fraud and claims abuse.

APPRAISE calculates multiple probability-based measures to rank individuals who transact with a Health Fund based on several key behavioural indicators. The results from APPRAISE’s analyses are presented as a dashboard with graphs that clearly identify how individuals compare to their peers in terms of the indicators. This information alerts the Health Fund investigators of the potential need to audit.

APPRAISE was developed in cooperation with HCF. For more information about APPRAISE please read our APPRAISE Case Study.