Case Management
Lead intake, SIU case investigation, recovery tracking, trackers, dashboards, and custom reports in one audit-ready workspace.
Learn more about Case ManagementHealthcare Program Integrity Suite
Detect fraud. Investigate faster. Recover more.
AEGIS ISD is a unified healthcare program integrity platform that combines prepay and postpay claims detection, SIU case management, medical review, provider document requests, and recovery tracking in one audit-ready workspace. Built for Medicaid, Medicare, and commercial health plans.
Product Suite
Seven products. One unified platform.
Medical Review
Clinical and coding review with line-level decisions, QA, appeals, and SVRS sampling with extrapolation.
Learn more about Medical ReviewProvider Portal
Secure document requests to providers with verified uploads, automatic reminders, and a full activity trail.
Learn more about Provider PortalDetect
Prepay claim screening, postpay detection, and provider link analysis, with 100+ base rules and CMS NCCI, MUE, and MS-DRG edits.
Learn more about DetectDataBridge
Data integration that loads, validates, and publishes claims, provider, and member data without one-off ingestion work.
Learn more about DataBridgeAI
Context-aware AI assistance with evidence-linked summaries and recommended next actions.
Learn more about AIDrive
Document evidence workspace with version history, permissions, and record links.
Learn more about DriveHow It Works
From suspicious signal to defensible outcome in four steps.
AEGIS ISD connects every phase of the healthcare fraud investigation lifecycle. Unlike legacy platforms that require manual handoffs between detection, investigation, and recovery, our unified workflow moves cases from signal to outcome with evidence captured at every step.
Step 01
Ingest
Normalize claims, provider, member, and external intelligence data into a unified case record.
Step 02
Score
Apply configurable rules, risk models, and fraud indicators to prioritize high-value alerts.
Step 03
Investigate
Manage evidence collection, clinical collaboration, peer review, and case determinations.
Step 04
Resolve
Capture outcomes, overpayment recoveries, corrective actions, and regulatory referrals.
Key Workflows
A healthcare fraud detection platform built for program integrity teams.
AEGIS ISD is a healthcare fraud detection and case management platform designed for Special Investigations Units (SIUs), program integrity departments, and medical review teams. Unlike legacy FWA platforms that require separate modules for detection, investigation, and recovery, AEGIS ISD unifies the entire fraud, waste, and abuse lifecycle in one configurable workspace.
SIU Case Management
Centralize evidence, communications, and determinations in one audit-ready case record for healthcare fraud investigations.
Fraud Detection & Triage
Prioritize fraud alerts with configurable rules, risk scoring, and automated routing to the right investigator or queue.
Medical Review
Coordinate clinical peer reviews, medical necessity determinations, and documentation workflows with structured evidence.
Provider Surveillance
Monitor billing patterns, utilization outliers, and high-risk provider networks with continuous surveillance dashboards.
Recovery Tracking
Track overpayments, recovery actions, and corrective measures from identification through resolution.
SVRS Sampling
Statistically Valid Random Sampling for healthcare claim audits: RAT-STATS-aligned methodology, Cochran's-formula sample sizing, Fisher-Yates random selection, Mean Per Unit extrapolation, with SVRS and extrapolation PDFs saved to the case.
Who We Serve
Built for the teams that protect healthcare programs.
AEGIS ISD serves program integrity teams across Medicaid, Medicare, and commercial health plans who investigate fraud, waste, and abuse.
Medicaid Managed Care Plans
Medicare Advantage Plans
Commercial Health Insurers
State Medicaid Agencies
Special Investigations Units
Program Integrity Departments
Health plans
Prepay and postpay detection, SIU case management, and medical review for commercial and Medicare Advantage payment integrity teams.
Payment integrity for health plans →State Medicaid and government
Detection, investigations, medical review, and statistically valid sampling for program integrity units, MFCUs, and PI contractors.
Medicaid program integrity →Special investigations units
One case record from first lead to final recovery, with records requests, review, sampling, and a full audit trail.
SIU case management →AI & Security
Ask questions in context. Get answers you can act on.
AEGIS AI Assistant is a context-aware AI built into every screen of the AEGIS ISD platform. While viewing a case, lead, document, or provider profile, investigators can ask natural-language questions and receive evidence-linked summaries, similar case matches, and recommended next actions. It is not a generic chatbot — it understands your active investigation context.
AEGIS AI Assistant
Question: What should we prioritize before closing this investigation?
Recommended actions
Request missing clinical attachment from provider before determination. Run similarity analysis against 3 recently resolved provider fraud cases. Route to medical review queue — risk score exceeds clinical review threshold.
Evidence linked from 4 case documents, 2 provider records
SOC 2 Type II
Independently audited across all five Trust Services Criteria.
HIPAA
HIPAA-compliant safeguards for protected health information, with a BAA before any PHI is processed.
ISO/IEC 27001
Certified information security management system.
CSA STAR Level 1
Listed on the Cloud Security Alliance STAR Registry with a CAIQ self-assessment.
RBAC
Segment permissions by program, investigation type, and queue.
Tenant Isolation
Each organization's data is isolated in a dedicated database schema. No shared tables, no commingled PHI.
Audit Trail
Actions, decisions, approvals, and exports are captured in a timestamped audit trail ready for regulatory review.
FAQ
Common questions about AEGIS ISD.
What is AEGIS ISD?
AEGIS ISD is a healthcare program integrity platform that unifies fraud detection, SIU case management, medical review, and recovery tracking in one workspace. It is designed for Medicaid, Medicare, and commercial health plan program integrity teams who investigate fraud, waste, and abuse.
Who uses AEGIS ISD?
AEGIS ISD is used by Special Investigations Units (SIUs), program integrity departments, medical review teams, and compliance officers at health plans and state Medicaid agencies.
How is AEGIS ISD different from legacy FWA platforms?
Unlike legacy platforms from vendors like Cotiviti, Optum, or SAS that require separate modules for detection, case management, and analytics, AEGIS ISD provides a unified workspace where all investigation activities happen in one place. It also includes a 5-level graduated AI trust model, schema-per-tenant data isolation, and no-code workflow configuration.
How does AEGIS ISD support prepay and postpay detection?
AEGIS ISD Detect uses one governed rule library for both payment stages. Before payment, it screens pending claims and recommends deny, suspend, review, or flag for reviewers in a prepay review workspace. After payment, detection runs scan paid and adjusted claims and route risk-scored alerts to analysts, who can convert them into Case Management leads.
Can workflows be configured for different programs?
Yes. Queues, SLAs, review stages, evidence requirements, risk scoring rules, and approval paths are fully configurable by line of business — Medicaid, Medicare, or commercial — without custom code.
How does AEGIS ISD support audit readiness?
Case decisions, evidence, approvals, and status changes are captured in a timestamped case timeline and audit trail, and audit records can be exported for regulator or internal compliance review.
Get Started
Ready to modernize your healthcare fraud detection?
Schedule a demo tailored to your program integrity workflows, data sources, and investigation requirements.