Popular Solutions
Emdeon Fraud Prevention Services
Emdeon Fraud Prevention Services help remove unnecessary costs from healthcare by identifying claim aberrancies and catching potentially fraudulent, abusive or wasteful claims early in the claim lifecycle, even pre-adjudication. Utilizing advanced technology that includes powerful, data-driven predictive analytics, clinical fraud alerts and more than 16 million clinical code edits, Emdeon can help payers reduce the amount of false positives, minimize costs and improve detection capabilities by automating processes and improving efficiencies. Because our solutions are flexible and modular, they integrate seamlessly with existing systems and can be customized to meet an organization's current and future needs. Our combination of technology, experienced investigators and innovative tools offer a complete and unparalleled fraud solution.
Want to reduce your exposure to fraud? Let the healthcare efficiency experts review your business and apply our knowledge to your bottom line.
Contact UsFeatures
- Multiple fraud-identification tactics detect aberrant claims:
- Proprietary database and data mining systems
- Data-driven predictive analytics
- Clinical aberrancy rules and alerts
- Can operate in various positions within the claims lifeycle:
- pre-adjudication
- post-adjudication/pre-claim payment
- post-claim payment (retrospective)
- Experienced investigators track and analyze abnormal claims data
- Automates manual processes
- Onsite medical director and staff clinicians
Benefits
- Improves savings opportunities by identifying both known and unknown fraud schemes
- Adapts to your current and future business needs
- Increases likelihood aberrant claims are detected
- Saves time and improves efficiency
