Born of necessity—built for results.

ClaimsVue is a collaborative platform with customizable and scalable dimensions that cover a broad range of common and trending health care fraud and quality issues.

• Uncover payment integrity issues within your claims data
• Prioritize actions
• Identify actionable improvements

Developed to support our own program integrity efforts, Qlarant created ClaimsVue to digest the large amount of data required to analyze medical claims in a meaningful and impactful way. This program is the result of years of subject matter expertise and state-of-the-art technology.

We’ve done the work—we want to share it with you

Qlarant is a national leader in providing our customers with trusted claims review information. This service is a means for digesting large amounts of data and providing analytics that identify, prioritize and most importantly, identify action items to reduce FWA. We are proud to present our easy-to-use application engineered to move your claims program to the next level.

Give us your data—we’ll give you insights

ClaimsVue Health is a scaleable fraud, waste, and abuse (FWA) suite that matches features and capabilities to your team’s needs at each stage of necessitiy. You choose the level that
matches the maturity of your program.

The FirstLook level provides analysis and insights delivered directly to your inbox. Over 50 years of FWA detection and prevention experience informs algorithms that search for the most common and trending schemes across multiple domains and trust factors.

FirstLook provides “at a glance” insights highlighting top fraudsters and risk exposure prioritizing where you should direct modifications.

More than numbers—actionable analytics

ClaimsVue Analytics is a step up from just knowing where to look—it prepares you for action. Configure, schedule, and run standard claims analysis across durable medical equipment, lab services, transportation, and more. Collaborate within your team, sharing health claims reports and visuals encompassing provider behaviors such as over utilization, billing, and spike
rendering. Become a crosswalk powerhouse with tools for claims inspection and peer group analysis.

Find high value targets—make better decisions

With ClaimsVue Discovery your organization will employ analytics to engage providers and enforce compliance. Explore provider behaviors across health plans, drill down from high level compliance trust factors to individual claims and send initial finding alerts to teammates. Engage providers with built-in tools used to create, save, and send compliance letters from successfully used templates. Discovery also features an enhanced FirstLook Recovery Spotlight summarizing the path to the most probable and potential recovery
from a provider of interest.

A comprehensive solution for recovery efforts

ClaimsVue Recovery is for the most advanced units seeking a comprehensive solution for recovery efforts. Configure and tune proven workflows for conducting audits, recovering overpayments, and building cases. Build a provider dossier and package pictures, medical records, and other documents for delivery to legal offices and the law enforcement. Manage your teams and report to stakeholders using case reports designed from decades of FWA investigations.