SentinelFWAPayment integritySynthetic, de-identified demo dataset
Find the dollars leaving before they leave.
SentinelFWA reads EDI 837 professional claim files, stores them claim line by claim line, and scores every claim across nine fraud, waste and abuse schemes. Every flag arrives with its evidence, severity, confidence and the recommended next action — ready for an audit file.
Intake that keeps its receipts
Upload an 837P file and see parsed claims, service lines, units and charges before anything is committed to the claim store.
Rules plus risk scoring
Weighted rule hits and confidence combine into a 0-100 claim risk score, rolled up to provider risk ranking and monthly trend detection.
An investigation queue that holds up
Findings become assignable cases with priority, status, dollars at risk and the evidence narrative attached.
Detection coverage
- Duplicate billing
- Unbundling
- Upcoding
- Medically unlikely edits
- Excessive units & frequency
- Billing after date of death
- Provider-member collusion
- Cost & utilisation outliers
- Rapid repeat claims