Alert Queue
Prioritized alerts with severity, status, score, program, rule, provider, member, and operational ownership. Filter, sort, and batch-action across the queue.
D
AEGIS ISD Detect
Alert-based detection for rules-driven program integrity teams.
Detect operationalizes healthcare fraud rules into prioritized alert queues, scoring dashboards, detection run history, link analysis, and optional handoff into Core leads when Core is deployed.
Capabilities
Turn detection logic into operational alerts.
Scoring Dashboard
Aggregated risk scores and patterns. Understand which rule signals contributed to alert priority. Drill into individual score components and contributing claims.
Detection Runs
Batch and real-time rule execution with full run history. Track when rules executed, what data was evaluated, and which alerts were created or updated.
Link Analysis
Provider, member, and claim relationship mapping. Analyze connections between entities, addresses, billing patterns, and alert clusters to surface hidden networks.
Configurable Alerts
No-code rule configuration for alert thresholds, severity levels, and routing logic. Manage templates and rules-driven triage without custom development.
Core Handoff
One-click lead creation from qualified alerts. When Core is deployed, alerts become leads with evidence, score context, and rule provenance attached automatically.
Who it's for
Built for teams that operate on alerts.
- Alert Operations Teams
- Program Integrity Analysts
- Fraud Strategy and Detection Teams
- Compliance and Audit Teams
- SIU Supervisors reviewing alert-to-lead conversion
What the demo covers
- Alert queue workflow and batch actions
- Scoring dashboard with rule signal drill-down
- Rule configuration and threshold management
- Link analysis visualization and entity mapping
- One-click Core handoff with evidence preservation
FAQ
Common questions about AEGIS ISD Detect.
Does Detect require Core?
No. Detect operates independently for alert operations. If Core is also deployed, qualified alerts can become Core leads with one click, preserving evidence, score context, and rule provenance.
What types of fraud rules does Detect support?
Detect supports upcoding, unbundling, impossible day, utilization outlier, eligibility gap, pharmacy and DME irregularity, and network/Stark/AKS adjacency rules. Custom rules can be authored in the no-code rule builder.
Can rules run in real-time or only in batch?
Both. Detection runs support scheduled batch execution against claims data and real-time rule evaluation when new data arrives. Run history tracks execution times, data volumes, and alert outcomes.
How does link analysis work?
Link analysis maps relationships between providers, members, claims, addresses, and entities. It surfaces hidden connections, billing pattern similarities, and geographic clustering that indicate coordinated fraud schemes.
How are alert scores calculated?
Scores are aggregated from individual rule signal contributions. The scoring dashboard breaks down which rules fired, their weights, and the specific claims or patterns that triggered each signal. Scores are explainable and auditable.