Lead intake and triage
Capture leads by manual entry, referral, or from Detect alerts. Work them in a lead workbench with bulk assignment, approve or reject, duplicate checks, escalation, and Excel export.
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AEGIS ISD Case Management
Leads, cases, recovery, and reporting in one investigation workspace.
Case Management, formerly AEGIS ISD Core, is the operational home for SIU and program integrity teams. Take a lead from intake to a closed case with recovery, outcomes, and reporting, all in one audit-ready record.
Configurable workflows
Recovery tracking
~50 dashboard widgets
Scheduled reports
Investigate
Every step from first signal to closed case.
Configurable prioritization
Administrators define scoring scales for lead source, allegation type, and dollars at risk. Every lead and case gets a consistent priority score and level.
Case lifecycle
Configurable stages, substages, and tasks with stage approvals, triggered follow-up stages, and close or reopen with required reasons. System notes record each transition.
Allegations, subjects, and claims
Record allegations with CPT codes, subjects and entities, related cases, and audits. Import claims with automatic column mapping and claim de-duplication.
Entity index
Search provider and member profiles by NPI, member ID, or other identifiers. See a scorecard, billing and risk charts, a timeline, notes, and related casebooks.
Workboards and queues
My Workboard for investigators, a Team Board for supervisors with assigned, unassigned, and approval views, and a cross-organization Global Queue with keyword search.
Recover and report
Track what was found, what was recovered, and what it means.
Recovery and outcomes
Track financial actions from pending to executed across billed, paid, suspect, repriced, overpayment, and recovered amounts. Also record referrals, corrective actions, and law-enforcement outcomes.
Trackers
Administrators build multi-page trackers for cases, leads, and medical reviews with computed and date fields, import and export, and visible gaps in required data.
Project tags
Tag cases, leads, medical reviews, and entities by project. Filter grids, drill into tagged work, and report on projects across dashboards and custom reports.
Dashboards
About 50 role-aware widgets with sharing, tenant-local date ranges, per-widget XLSX export, dashboard PDF export, and an audited export log.
Custom report builder
Build reports across leads, cases, and medical reviews with calculated fields, drill-down to records, and AI-assisted drafting. Schedule delivery by email or Drive as XLSX, CSV, PDF, or HTML.
Executive workspace
A cross-organization view for leadership: KPI tiles with trends, an organization-health table, a needs-attention panel, executive custom reports, and scheduled delivery.
Governance
Controls built for regulated investigations.
Role-based access, jurisdiction scoping, and a complete audit trail are part of every record, not add-ons.
- Twelve system roles, from intake analyst to supervisor and administrator
- Jurisdiction scoping so teams only see the work they are responsible for
- Per-organization terminology for records, stages, and fields
- In-app and email notifications, personal reminders, and announcements
- Workflow configuration export and import with a preview before applying
- Complete audit trail of record changes, approvals, and exports
Works with
One platform, connected products.
Shared identity, permissions, tenant isolation, and audit history across every AEGIS ISD product.
Medical Review
Clinical and coding review of claims from a case, with QA and SVRS sampling.
Explore Medical ReviewProvider Portal
Request medical records from providers and track every step until the request is complete.
Explore Provider PortalDetect
Convert prepay and postpay detection alerts into leads with the evidence attached.
Explore DetectAEGIS AI
Evidence-linked summaries and report drafting from the active case.
Explore AIAEGIS Drive
Case documents and evidence with version history and permissions.
Explore DriveDataBridge
Load claims, provider, and member data without one-off ingestion work.
Explore DataBridgeWho it's for
Built for the teams that investigate and resolve.
- Special Investigations Units (SIU)
- Program integrity departments
- Recovery and corrective action teams
- Compliance officers and supervisors
- Intake analysts and lead triage teams
- Program integrity leadership
Running a Special Investigations Unit? See SIU case management software for health plans.
What the demo covers
- Lead triage, prioritization, and conversion to a case
- Case stages, approvals, and the activity timeline
- Recovery tracking and financial outcomes
- Trackers, project tags, and workboards
- Dashboards, custom reports, and scheduled delivery
- The executive workspace
FAQ
Common questions about AEGIS ISD Case Management.
What happened to AEGIS ISD Core?
Core is now AEGIS ISD Case Management. Medical review and provider document requests, which were part of Core, now have their own product pages: Medical Review and Provider Portal. They still run on the same platform with the same users, permissions, and audit history.
What investigation types does Case Management support?
Fraud, waste, and abuse investigations for Medicaid, Medicare, and commercial health plans. Stages, substages, tasks, approvals, and prioritization scales are configured by administrators without code changes.
How do leads become cases?
Leads arrive by manual entry, referral, or from Detect alerts when Detect is deployed. After triage, an analyst opens a new case from the lead or links it to an existing case. The lead context carries over.
Can we report across all of our organizations?
Yes. The executive workspace gives leadership a cross-organization overview, and executive custom reports can be scheduled for email delivery.
Can Case Management run without Detect or DataBridge?
Yes. Case Management is a standalone product. Detect and DataBridge add automated alert intake and governed data loading when you need them.