Franklin, TN – July 7, 2025 – Prime Health Services, Inc., a national PPO network and healthcare cost containment company, has partnered with 4L Data Intelligence™ to bring a more advanced layer of fraud, waste, and abuse (FWA) detection to its bill review services. The collaboration introduces Adaptive Bill Review powered by 4L Data’s patented Integr8 AI Risk Detection™ technology, a provider-centric solution designed to identify potential FWA risks such as abusive billing, behaviors, relationships, and schemes in near real-time.
Traditional claims review processes often rely solely on static, claims data-centric rules and miss the continuously changing behaviors and relationships that are associated with either individual overbilling or complex, multi-provider collusions that cause major harm to plans. Prime Health’s Adaptive Bill Review, goes beyond conventional, static bill review process by integrating dynamic provider behavior analysis, continuously monitoring for overbilling, suspicious patterns, and credential concerns—before payment is made. This has been proven to help payers and employers reduce total claims costs by an estimated 5% to 15% over-and-above conventional bill review and claims editing methods. .
“This solution gives our clients a smarter and more proactive way to address billing issues early in the process,” said Scott Nocon, Chief Operating Officer at Prime Health Services. “It enhances what we already offer, adds greater confidence in the integrity of payments, and reduces the administrative burden associated with manual and rules-dependent options.”
Key Benefits Include:
AI-Driven Insight: Powered by patented Integr8 AI Risk Detection™, offering dynamic analysis beyond static rules-based systems.
Real-Time Overpayment Detection: Identifies incidents and patterns of fraud, waste, abuse, and error (FWA) based on current and historical claims submissions, behaviors, relationships, and patterns.
Continuous Credentials & Integrity Monitoring: Flags high-risk or ineligible providers using 93+ daily-refreshed data points on every claim with continuously updated provider integrity data
Minimal IT Impact: Easily integrates with existing claims workflows.
About Prime Health Services
Prime Health Services, Inc. is a leading healthcare technology company delivering innovative, customizable medical cost containment solutions across the U.S. Powered by our proprietary Renovo platform, we streamline claims processing, accelerate bill review, and provide real-time access to national PPO networks—serving clients in workers’ compensation, auto liability, group health, personal injury, and more. Since 2001, Prime has empowered insurance carriers, TPAs, self-insureds, employers, and government entities with flexible technology that doesn’t compromise on speed, savings, or care access.
About 4L Data Intelligence™
4L Data Intelligence is the Integr8 AI Risk Detection™ technology powered program and payment integrity company focused on helping our customers and partners deliver better healthcare, insurance, and government services at a lower cost by improving data, provider, payment and decision integrity. The company is committed to using the power of Integr8 AI™ for good by helping healthcare payers, health systems, governments and insurers deliver better care and services while reducing billions of dollars in out-of-control costs. For more information visit 4LData.com.
To learn more or request a demonstration, contact sales@primehealthservices.com or visit www.primehealthservices.com.