01
Signal Detection
Statistical models, analytical methods and deterministic rules can surface unusual activity for investigation. Each result is an investigative signal, never a verdict.
Healthcare claims integrity
Claims integrity works better when patterns connect.
Sequrin is being built to help healthcare claims-integrity teams identify signals, investigate connected activity and understand relationships that isolated claims may not reveal.
For medical schemes and authorised claims-integrity teams
The problem
The signal is often bigger than a single claim.
Investigations frequently take place within fragmented datasets and organisational boundaries. A single claim may look entirely ordinary on its own.
Claim
Ordinary in isolation
Provider
Repeated referral pattern
Member
Recurring across providers
Facility
Shared submission window
Timing
Clustered, near-duplicate
Behaviour
Deviation from peer group
Seen together, these can reveal a pattern that warrants closer examination: a question worth investigating.
Product
Four capabilities, built around investigation.
02
Network Intelligence
Relationships between claims, providers, members, facilities and organisations can reveal patterns that individual records may hide.
03
Investigation Workspace
Claims-integrity teams can examine signals, evidence and connected entities through a structured investigative workflow.
04
Controlled Collaboration
Sequrin is being designed to support governed sharing of relevant integrity information between authorised participants while preserving accountability and organisational boundaries.
Human oversight
Built for investigation, not automated judgement.
Step 1
Detection
Models, rules and network analysis run over governed data.
Step 2
Signal
An output is a prompt to look closer, not a finding of fraud.
Step 3
Investigation
Evidence, relationships and context are examined by people.
Step 4
Human decision
Consequential outcomes remain with accountable processes.
Detection creates a signal. Investigation establishes context. Humans remain responsible for consequential decisions.
- Suspicious does not mean fraudulent.
- Analytical models help prioritise questions, not assign guilt.
- Evidence and context must be investigated before conclusions.
- Sequrin does not reject claims, withhold payment or impose sanctions.
How Sequrin works
A governed path from data to decision.
1
Connect
Relevant claims and integrity data enter a governed analytical environment.
2
Detect
Rules, statistical methods, models and network analysis identify patterns worth examining.
3
Investigate
Authorised investigators review evidence, relationships and contextual information.
4
Collaborate
Where appropriate, governed integrity information can support responsible cross-organisational awareness.
Secure Integrity Network
From isolated signals to shared integrity intelligence.
Individual organisations naturally have visibility into their own claims environment. Some potentially significant relationships, however, may only become apparent when appropriately governed information can be understood across organisational boundaries.
Sequrin is being built toward infrastructure that can support this broader claims-integrity view. This is the concept behind the name: Sequrin, pronounced “Securing”, meaning Secure Integrity Network.
This is a development direction, not an operating national network. Current work is focused on the analytical and investigative product.
Intended users
Who Sequrin is for.
- Medical schemes
- Claims-integrity teams
- Forensic investigation teams
- Healthcare administrators
- Other authorised healthcare claims stakeholders
Product principles
Principles that shape the architecture.
Human oversight
Analytical signals support investigators rather than replacing accountable human decision-making.
Evidence before conclusions
A suspicious pattern is something to investigate, not proof of misconduct.
Governed access
Sensitive claims-integrity information should only be available to appropriately authorised users.
Auditability
Important investigative and administrative actions should be traceable.
Responsible collaboration
Cross-organisational information sharing should occur through controlled, accountable processes.
Building stronger infrastructure for claims integrity.
Sequrin is an early-stage technology product being developed for the healthcare claims-integrity environment. For product, partnership, pilot or other business enquiries, get in touch directly.