Healthcare Analytics

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Payment Integrity

Fraud, Waste and Abuse

Opioid Utilization

Critical Incidents


Payment Integrity


Through a simple web browser-based interface, our suite of Payment Integrity tools allows you to:

  • Measure and understand the way your program or plan pays for services from multiple dimensions: procedure code, provider type, specialty, claim types
  • Find efficiencies or deficits in your provider network or reimbursement structure
  • Make informed decisions regarding reimbursement or policy changes, and then track the effects over time
  • Uncover geographic hotspots or areas with service deficiencies


Spreadsheet-146x142Fraud, Waste and Abuse

Root out bad providers and identify improper payments with Pulselight’s Fraud, Waste & Abuse Solution:

  • Take advantage of pre-built analysis tools such as Impossible Days, Inpatient Overlap and Shared Patients
  • Construct and analyze suspicious provider billing behaviors in real time
  • Easy-to-understand, interactive charts that visualize the situation and clearly point to bad actors
  • Discover provider networks and hidden connections using the Pulselight Graph
  • Gain instant insight with provider and member Profile Pages

pillbottle120x129Opioid Utilization

With the Pulselight Opioid Utilization Solution you get:

  • The right measures to illuminate and act on opioid addiction, overdose, over-prescribing and improper filling
  • Clear understanding of dangerous overlapping drug combinations
  • Easy-to-understand, interactive charts that visualize situations and trends
  • Seamless blending of pharmacy claims and patient medical history
  • The intelligence you need to take the right actions and track their progress

Shining a Light on Opioid Abuse

Download the MME Calculator

critical-incidentCritical Incidents

Use the claims/encounter data you already have to protect those most vulnerable:

  • Proactively identify incidents of injury, illness or death for at-risk populations in various settings:
    • Developmentally disabled in group homes
    • Elderly or disabled in nursing homes
    • Foster children in group homes
    • At-risk members in home care settings
  • Quickly identify those in need of help, and facilities with evidence of abuse or neglect
  • Make use of diagnosis-based incident categories to better understand patterns
  • End the reliance on voluntary incident reports as your only means of detecting danger