Fraud Prevention Can’t Wait 45 Days

If it takes over a month to get medical records, it’s already too late.

In fraud, waste, and abuse (FWA) investigations, the gap between flagging a case and taking action determines how much is recovered or how much is lost.

Across the industry, medical record retrieval still takes 30-45 days, requiring repeated outreach to providers, re-sending requests, and manually processing incoming records while improper payments continue unchecked.

From 45 Days to 24 Hours

Commence’s FWA solution combines our automated record outreach and retrieval capabilities with Healthcare Fraud Shield’s advanced fraud detection technology to reduce record retrieval timelines from over a month to just 24 hours.

The process starts the moment a case is flagged. A first request is sent within three hours via secure fax, leveraging Commence’s Health Information Exchange (HIE) connections to verify or locate provider fax numbers. If no response is received, a second attempt is made within seven days. Every request uses client-specific templates with barcode coversheets, allowing returned records to be automatically tagged to the correct provider, member, and case.

When records arrive—whether by secure fax, mail, or the Commence portal—they are digitized, indexed, and time-stamped. Our AI-based digital intake uses Natural Language Processing (NLP), computer vision, and generative AI to extract, classify, and structure relevant medical insights. The completed package is delivered to HCFS via Application Programing Interface (API), ready for ingestion into fraud detection workflows. Throughout the process, the system maintains a complete audit trail, with dashboards and unlimited reporting options for tracking progress and performance.

Protecting Program and Patient Health

Slow record retrieval creates both compliance risk and financial strain. Missed audit deadlines, penalties, and delayed recoveries all add to program costs.

Accelerating this process changes outcomes entirely. It allows fraud to be confirmed in hours rather than weeks, improper payments to be stopped before they are made, and administrative costs per case to drop. That means more program dollars fund care instead of covering losses. When data is accurate, accessible, and actionable, it drives better answers, faster decisions, and improved services for those who depend on them.

The result is fewer compliance issues and stronger program integrity, ensuring the mission can stay focused on protecting care and the people it serves.

Built for Every Market

The FWA solution is adaptable across the healthcare ecosystem. For commercial health plans, it clears investigations backlogs, improves payment integrity, and supports contract requirements. For state and commercial programs, it keeps teams audit-ready without overloading limited staff. And for large health systems, it flags fraudulent provider billing patterns earlier and safeguards payer contracts from risk.

The Future of FWA Prevention

Fraud prevention is about delivering the right records to the right decision-makers in time to make a difference.

Through Commence, retrieval that once took weeks now takes hours. By combining Intelligent Data Exchange, Automated Medical Records Retrieval & Review, and AI-Based Digital Intake, the solution equips organizations to move quicker, strengthen compliance, and protect the care their programs were built to deliver.

This is greater data for the greater good—proving that quality data, applied with unmatched precision, transforms not only program outcomes, but also the lives of the people those programs serve.

Learn more about our Fraud, Waste & Abuse solution.