Payment integrity solutions that begin and end with you saving. Pay Right. Save Money.
Preventing fraud, waste and abuse with the Clinical Touch. HealthCare Insight | A Division of Verisk Health
A Nucleus Solution
PhysicianClaim INSIGHT
速
Fraud, waste & abuse for professional health care claims >
It Takes a
Clinical Expert to diagnose Fraud.
Prevent Fraud | Improve Accuracy | Reduce Costs
PhysicianClaim insight
ÂŽ
Maximize your claims payment accuracy, identify fraudulent providers and reduce your professional claims costs.
Animated graphs, interactive charts and real-time updates help to simplify your workload and expedite actions on your provider’s claims.
14
Prevent Fraud | Improve Accuracy | Reduce Costs
THE
THE
Problem
Solution
Fraud Stats 3% – 10% of US physician and clinical care outlay is lost to fraud. By 2013, losses could reach $63 billion.
Results >> Reduce expenditures up to $4 PMPM >> Improve claims payment accuracy up to 10% >> Increase annual profitability up to 5%
$63.6 $60.4 $57.7
(In Billions)
$55.2 $18.1
$19.1
$17.3 $16.6 2010
2011
2012
2013
Features >> Prepayment analysis on 100% of professional claims >> Clinical review on all suspect claims and providers >> Code Validator Pro® — Rules-based editing >> Fraud Finder Pro® — Provider profiling and scoring >> Highly customizable rules and parameters >> Real-time claims processing and ad hoc reporting >> Clinically-driven appeals support and response >> Daily notification of suspect providers and claims >> Easy to use web-based application >> Total professional claims cost-containment solution
Fraud Projections for Physician & Clinical Services 2010 – 2013 / 3 – 10% Loss 10% Loss 3% Loss
Next Steps Contact us for a complimentary Cost Reduction Analysis. Call 1.877.619.5557 or email info@hcinsight.com today.
“We have experienced positive changes in provider billing habits resulting in significant savings.” – Mary Alice Garcia, BA, CPC Medicaid MCO www.hcinsight.com
15
Why you’ll
Like Us.
CLINICAL REVIEW BY MDs, RNs & DDS’ >
Detailed ad-hoc Reporting >
PREPAYMENT SaaS SOLUTION >
Appeals Support & Response >
TOTAL Payor CUSTOMIZATION >
IMMEDIATE REALIZATION OF ROI >
Real-Time Claims Processing >
Solutions for all Payor Types >
memberships & Accreditations
36
Prevent Fraud | Improve Accuracy | Reduce Costs
how to P
Phone
877.619.5557
S
F
Contact Us. Fax
801.285.5801
Connect With HCI
Twitter | Facebook
Linkedin | YouTube
M
E
info@hcinsight.com
R
W
Web
www.hcinsight.com
HCI Fraud Resources
www.profilermag.com www.stophealthcarefraud.com
HealthCare Insight 10897 S. River Front Parkway Suite 200 South Jordan, UT 84095
© 2010 HealthCare Insight – A Verisk Health Company. HealthCare Insight, PhysicianClaim Insight, DentalClaim Insight, FacilityClaim Insight, PharmaClaim Insight VisionClaim Insight, Code Validator Pro and Fraud Finder Pro are registered service marks and trademarks of HealthCare Insight. All other product or corporate names are trademarks or registered trademarks of their respective companies. Fraud loss figures based on Centers for Medicare & Medicaid Services (CMS) spending projections and National Health Care Anti-Fraud Association (NHCAA) loss estimates.
HealthCare Insight 10897 S. River Front Parkway Suite 200 South Jordan, UT 84095
Phone 877.619.5557 Email info@hcinsight.com Web www.hcinsight.com