Wake Up to Insights with Healix ☀️
Healthcare data shouldn’t just sit in a database — it should work for you. That’s why we built Healix, a healthcare data mining platform designed to deliver real-time intelligence, powerful visualisations, and advanced analytics — all without your team lifting a finger.
Every morning at 6 AM sharp, your day starts with our “Good Morning” Report — a beautifully simple summary packed with all the healthcare claims processed in the past 24 hours. It’s your first insight of the day, helping you stay informed, proactive, and one step ahead of emerging patterns or irregularities.
Real-Time Fraud, Waste & Abuse Detection 🛡️
Healix brings a new level of vigilance to healthcare claims processing with built-in, real-time detection of Fraud, Waste, and Abuse (FWA). Each claim is evaluated the moment it is submitted — using a blend of rules-based logic, anomaly detection, and machine learning — to flag:
- Unusual billing patterns
- Medically implausible claims
- Duplicate or excessive services
- Provider outliers
- Suspicious diagnostic/procedure combinations
Flagged claims can be paused or routed for review before payment, enabling schemes to act before the money leaves the system.
Monthly Reviews with Humans (and AI)
Once a month, we take things further. Our expert data scientist and clinical specialist present an in-depth report tailored to your scheme. This isn’t just raw data — it’s a guided tour through your risks, trends, anomalies, and opportunities for impact.
We include a retrospective fraud audit powered by Healix — surfacing outlier providers, billing abuses, repeat offenders, and systemic patterns of leakage or manipulation. These reviews help you spot not just individual claim issues, but strategic fraud behaviors that develop over time.
Your Data. Our Problem.
Healix is delivered as Data Science as a Service (DSaaS) — which means you don’t need to worry about infrastructure, servers, storage, or scaling. We handle everything. All you need is an internet connection and a desire to make smarter decisions.
Need help with a custom investigation? Whether it’s a sudden spike in chronic disease codes, excessive back procedures, or suspicious high-cost members — we’re already on it. You’ll get a crisp, actionable summary that saves you time and helps you respond with confidence.
Retrospective Pattern Mining 🔍
In addition to real-time detection, Healix continuously mines historical claims data to detect long-term trends in FWA, including:
- Provider clustering
- Ghost billing
- High-cost member profiling
- Unbundling and upcoding schemes
We combine advanced analytics with human review to catch what other systems miss.
Benchmarking with Industry Data 📊
One of the most powerful features of Healix is our Comparison Report — a benchmarking tool that allows your scheme to compare its claims behavior against aggregated industry data.
Want to know if your members are receiving more spinal surgeries than the national average? Curious if your chronic medication costs are higher than peers? Our comparison report highlights key deviations, risk indicators, and outliers, giving you the confidence to act.
Using anonymised and aggregated data across participating schemes, we deliver rich context for your internal trends — so you’re not just looking at yourself in a vacuum. You’re seeing how you measure up, what’s normal, and where attention is needed.
Bonus Power-Ups 🚀
- 📄 AI Document Library App – Upload PDF docs, search with natural language, and get instant summaries or answers.
- 🤖 ML Model Creation – Need to predict claims risk, member dropout, readmission likelihood, or fraud probability? We’ll build the model, train it, and explain it.
Why Healix?
Because you deserve a partner who’s not just collecting your data — but unlocking its full potential. With Healix, your scheme becomes smarter, more responsive, and data-driven from the ground up.
Let’s turn data into decisions. Let’s make healthcare smarter. Let’s do it together.