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Computer software for use by the health insurance care industry providing detection of overpayment and fraud, waste and abuse in healthcare billing by screening claims for aberrant patterns in utilization, coding mismatch and billing/payment activities; computer software for use by the health insurance care industry providing analytic tools and customizable reports, administrative and workflow components and statistical algorithms for pre-pay and post-pay prevention, early-warning identification, detection and optimum workload/caseload management in healthcare billing