Stop paying for what you don't owe.
Duplicate billing, upcoding and diagnosis mismatches look harmless one claim at a time and add up to real loss across the book. Ajé catches them across your whole book, before the money leaves, so the leakage stops hitting your loss ratio.
Across your whole book, not one claim at a time.
Recover what hides across the book
Behaviour that looks normal on a single claim stands out across a provider's history and against peers. Ajé surfaces the outliers no single reviewer would connect, turning invisible leakage into spend you can question and refuse.
Duplicate and upcoding checks
Duplicate submissions and claims coded to a higher-cost service than delivered are detected systematically, not by chance.
Diagnosis-to-procedure mismatches
Procedures and prescriptions that don't fit the stated diagnosis are flagged for review, tuned to the local disease burden rather than a foreign dataset.
Caught without slowing clean claims
Suspicious cases are surfaced for your investigations team with the evidence attached, while clean claims are unaffected.
Leakage is a pattern problem, not a claim problem.
Most fraud, waste and abuse is invisible one claim at a time. A single duplicate looks like an error; a single upcoded procedure looks like a judgement call. It is only across a provider's history, and against the behaviour of peers, that the pattern becomes obvious. Human reviewers cannot hold that much context in their heads, and a report that arrives after payment cannot undo the spend.
Detecting the pattern at the point of decision changes the outcome. Questionable claims are held before money leaves, providers who consistently bill outside the norm are surfaced, and your investigations team works from evidence instead of hunches, all without slowing down the clean claims that make up the majority of your book.
The patterns differ by market, but the method travels: Ajé runs this detection in Nigeria today and is built to extend it to health insurers across Africa.
What individual review misses, portfolio-scale pattern detection catches.
Fraud, waste & abuse, answered.
What is fraud, waste and abuse (FWA) in health insurance?
How does Ajé detect fraud that individual reviewers miss?
Does detection happen before or after payment?
Is the detection tuned to the Nigerian context?
Find the leakage in your own book.
We walk through fraud, waste and abuse detection on the claims patterns your team sees every day.