Claim Risk Profile
Which claims contain the strongest risk indicators and what evidence contributed to them?
Latttice for Medicare
Turn fragmented Medicare data into trusted claims, payment integrity and program integrity decisions.
Medicare claims environments contain enormous amounts of information across claims, providers, beneficiaries, payments, eligibility, authorizations, and supporting systems. The challenge is bringing the right information and context together at the moment a claim, provider, or payment needs to be investigated.
Latttice works across the technology and data estate you already run and enables teams to create governed, reusable data products for claims oversight, payment integrity, program integrity, investigation, and AI — without replacing the systems underneath them.
Evidence in one placeConsistent investigationPrioritized reviewAuthorized people decide
Why Medicare teams choose Latttice
Trusted claims intelligence, at the point of decision.
Latttice sits across the existing claims, provider, payment, and governance estate and lets the teams closest to the decision create governed data products that bring together the information needed to review claims, examine provider activity, validate payments, and prioritize cases for investigator attention.
Claims Integrity
Bring together the information needed to understand claims that contain unusual, inconsistent, or higher-risk indicators.
Payment Integrity
Identify paid claims and payment patterns that may warrant validation, review, or potential recovery investigation.
Provider Intelligence
Understand provider-linked claim activity and identify patterns that warrant closer examination.
Eligibility & Authorization
Bring eligibility, authorization, and claims context together so investigators can identify inconsistencies without manually navigating multiple systems.
Program Integrity
Prioritize claims, providers, and payment patterns for investigator review using governed data products.
Governance & Trust
Keep definitions, ownership, lineage, access controls, policy, and evidence attached to the information used by people and AI.
Common Medicare data products
Start with the decision. Build the trusted data product needed to make it.
Provider Risk & Activity
Which providers are associated with unusual or higher-risk claim patterns?
Payment Integrity
Which paid claims or payment patterns may require review, validation, or recovery investigation?
Duplicate Billing & Upcoding
Where do claim patterns indicate potential duplicate billing, upcoding, or excessive units?
Eligibility & Authorization
Which claims contain inconsistencies between eligibility, authorization, and billed services?
Program Integrity Intelligence
What patterns are emerging across claims, providers, payments, and populations that warrant investigation?
Existing Medicare technology
Your technology already exists. The missing piece is trusted business context.
We don't replace your claims, payment, provider, governance, or data platforms. We complete them. Latttice works across the systems and information already supporting Medicare claims oversight and turns that fragmented information into governed data products people and AI can use with confidence.
Existing Medicare systems and data
Claims systems
Provider information
Beneficiary eligibility & enrollment
Payments
Eligibility
Authorizations
Policy and program rules
Case / investigation systems
Document repositories
Data warehouses
Lakehouses
Snowflake
Databricks
Microsoft Fabric
Collibra
AWS
Azure
Other enterprise data platforms
Latttice
Data Product Workbench
ConnectCreateGovernPublishUse
Trusted Medicare data products
Claims
Providers
Payments
Eligibility
Risk
Program Integrity
Powering
DecisionsAnalyticsAI
No rip and replace — Latttice federates across the systems you already run.
Interactive product demonstration
See a claims integrity investigation come to life.
Human-in-the-loop · No autonomous claims action
The Medicare Intelligence Claims Fraud Agent demonstrates what becomes possible when AI can reason across trusted, governed claim risk data products. It surfaces risk indicators, explains what contributed to them, and helps prioritize items for review — while every determination stays with the authorized person. It is one demonstration within a wider Medicare data product solution, not the solution itself.
- Which claims have the highest fraud risk and why were they flagged?
- Which paid claims appear to have the largest payment integrity issue?
- Which providers are associated with the most high-risk claims?
- Which claims required authorization but do not have an authorization ID?
- Which claims show duplicate billing, upcoding, or excessive units?
- Which claims should be prioritized for manual review?
From risk signal to investigation
A Decision-Driven path from risk signal to investigation.
AI supports the investigation. Authorized people make the decision.
Risk Signal
Which claim, provider, or payment pattern may warrant attention?
Trusted Data Products
What do governed claims, provider, payment, eligibility, and authorization data tell us?
AI Reasoning
Why has the item been prioritized and what evidence or patterns contributed?
Investigation
What additional review, validation, or investigation should be considered?
Human Decision
An authorized investigator or claims professional reviews the evidence, applies professional judgment, and determines what happens next.
No rip and replaceFederated accessZero-code business-built data productsActive governanceFine-grained access controlComplete lineageMeasurable AI readiness
Questions teams can answer
Every data product starts with a decision that needs to be made.
Which claims require investigation first?
Why was this claim identified as higher risk?
Which paid claims may contain payment integrity issues?
Which providers are associated with unusual claim patterns?
Which claims appear inconsistent with authorization or eligibility information?
Where should investigator attention be prioritized?
Trusted data to AI
Give AI the business, policy, and claims context it needs to make useful recommendations.
Trusted Data Products
Governed, reusable claims, provider, payment, eligibility, and authorization information created from existing systems.
Business Context & Governance
Definitions, ownership, lineage, policy, program rules, access controls, and evidence.
AI Models & Agents
LattticeGPT and Lenz can reason across trusted information and approved knowledge rather than disconnected raw data.
Human Outcomes
Faster access to evidence, more consistent investigation, and better-informed claims and program-integrity decisions.
From trusted data to accountable decisions
AI assists. People decide.
Latttice enables AI to retrieve and reason over governed data products while keeping the underlying evidence available to the authorized person reviewing the result. Risk indicators are not fraud determinations.
No claim should be automatically denied, referred, recovered, or otherwise actioned simply because an AI model or agent identifies a risk indicator. Claims professionals, investigators, and authorized program personnel remain responsible for decisions.
Human-in-the-loop · No autonomous claims action · Evidence available behind every recommendation.
Human-in-the-loop
No autonomous claims action
Governed data products
Approved policy and program context
Fine-grained access control
Data lineage and provenance
Evidence attached to recommendations
Explainable reasoning
Existing identity providers
Existing governance platforms
Audit-ready activity
Common questions
Questions Medicare teams ask first.
Does Latttice detect Medicare fraud automatically?
No. Latttice creates governed data products and risk indicators that help investigators prioritize review. It does not make fraud determinations. Authorized people review the evidence and decide what happens next.
What Medicare data does a Latttice data product use?
Claims, provider, beneficiary eligibility and enrollment, payment, authorization, policy, and case information from the systems a payer or program already runs. Each data product carries its definitions, ownership, lineage, and access controls.
Does Latttice replace our existing Medicare claims systems?
No. There is no rip and replace. Latttice connects to claims platforms, data warehouses, lakehouses, and cloud platforms already in place and publishes trusted data products across them.
How is access to Medicare information governed?
Access controls, policy, ownership, and evidence stay attached to each data product, so the same governance applies whether information is used by a person, an analytics tool, or an AI agent.
How does a Medicare team get started with Latttice?
Start with one decision, such as claim prioritization or payment integrity review. Latttice creates the supporting data products from existing systems, then the same foundation supports adjacent decisions.
Choose your next step
Start with the Medicare decision that matters most.
Have a Medicare use case?
Tell us the Medicare claims, payment integrity, or program integrity decision you need to improve.
See Your Medicare Use CaseWant to see it working?
Explore the Medicare Intelligence Claims Fraud Agent as a decision-support demonstration.
Try the AgentReady to build?
Start a Latttice trial and connect your existing Medicare systems to governed data products.
Start a Latttice Trial