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
PharmaClaim INSIGHT
速
Fraud, waste & abuse for pharmacy claims >
Just the
right dose of pharmacy
Fraud Prevention.
Prevent Fraud | Improve Accuracy | Reduce Costs
PharmaClaim insight
速
Strengthen your claims payment accuracy, isolate fraudulent providers and reduce your pharmacy claims costs.
Share feedback, brainstorm with other users and post your own suggestions on how to improve Nucleus in the Idea Forum. Take part in the evolution.
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Prevent Fraud | Improve Accuracy | Reduce Costs
THE
THE
Problem
Solution
Fraud Stats 3% – 10% of US pharmacy claim outlay is lost to fraud. By 2013, losses could exceed $30 billion.
Results >> Reduce rising pharmacy expenditures >> Improve Rx claims payment accuracy >> Increase annual profitability
$30.8 $28.9 $27.2
(In Billions)
$25.6 $8.7
$9.2
$8.1 $7.7 2010
2011
2012
2013
Features >> Prepayment analysis on 100% of pharmacy 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 >> Full-service Rx claims cost-containment
Fraud Projections for Pharmacy Claims 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.
“HCI goes to bat for the client and the patient to be sure the provider is being fair and just.” – Orlo L. “Spike” Dietrich The Ansley Group www.hcinsight.com
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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