SHIELD™
A Provider Vetting Program for Your Medical Claim Portfolio
Proactive Protection. Intelligent Prevention. Measurable Savings.
SHIELD™ is a proactive provider vetting program designed to protect, monitor, and optimize your medical claim portfolio before costs escalate. Built as part of the CostFirst ecosystem and powered by HEAT™, SHIELD™ delivers real-time intelligence that enables smarter decisions across the lifecycle of a claim.
Identify Risk Before It Impacts Your Bottom Line
SHIELD™ utilizes a proprietary provider-identification framework to detect high-risk entities within your portfolio, including providers who are:
- Indicted or criminally charged
- Suspended or under regulatory review
- Connected through controlling or affiliated interests across entities
Through HEAT™, our system goes beyond standard industry alerts—identifying exposure earlier than traditional reporting channels, including detection of providers prior to official DIR suspension or declaration.
Embedded Across Your Entire Claims Ecosystem
SHIELD™ is not a standalone tool—it is seamlessly integrated across your operational workflows, including:
- Medical Bill Review (MBR)
- Medical Provider Networks (MPN)
- Requests for Authorization (RFA)
- Lien and Litigation Management (OptiMix™)
This integration ensures that risk detection is continuous, not reactive, allowing your team to take action at every decision point.
Avoid Unnecessary Payments. Strengthen Claim Integrity.
By embedding SHIELD™ into your claims process, you can:
- Prevent payments to high-risk or ineligible providers
- Reduce exposure to fraudulent or abusive billing practices
- Strengthen SIU collaboration with actionable intelligence
- Improve claim outcomes and reduce lifecycle costs
From Detection to Prevention
Most programs identify issues after financial exposure has already occurred. SHIELD™ shifts that paradigm—transforming provider intelligence into a prevention-first strategy.
Combined with HEAT™ and the broader CUBE™ platform, SHIELD™ enables a closed-loop ecosystem where detection, analysis, and action work together to deliver sustained cost containment and risk reduction.
