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Payment integrity solutions that begin and end with you saving. Pay Right. Save Money. HealthCare Insight | A Division of Verisk Health InSIghT A Nucleus Solution Fraud, waste & abuse for professional health care claims > ® IT TakeS a Prevent Fraud | Improve Accuracy | Reduce Costs
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Payment integrity solutions that begin and end with you saving. Preventing fraud, waste and abuse with the Clinical Touch.
Pay Right. Save Money.
HealthCare Insight | A Division of Verisk Health
PhysicianClaimInSIghT
®
A Nucleus Solution
Fraud, waste & abuse for professional health care claims >
IT TakeS a
Clinical Expert
To DIagnoSe Fraud.
Prevent Fraud | Improve Accuracy | Reduce Costs
14
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.
Prevent Fraud | Improve Accuracy | Reduce Costs
PhysicianClaim InSIghT
®
15
Fraud Stats3% – 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%
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
Next StepsContact us for a complimentary Cost Reduction Analysis.Call 1.877.619.5557 or email [email protected] today.
“We have experienced positive changes in provider billing habits resulting in significant savings.”
– Mary Alice Garcia, BA, CPCMedicaid MCO
Fraud Projections for Physician & Clinical Services 2010 – 2013 / 3 – 10% Loss
(In B
illio
ns)
$55.2
$57.7
$60.4
$63.6
$19.1$18.1
$17.3$16.6
2010 2011 2012 2013
www.hcinsight.com
10% Loss
3% Loss
The
SolutionThe
Problem
36 Prevent Fraud | Improve Accuracy | Reduce Costs
CLINICAL REVIEW BY MDs, RNs & DDS’ >
PREPAYMENT SaaS SOLUTION >
TOTAL PAYOR CUSTOMIZATION >
REAL-TIME CLAIMS PROCESSING >
DETAILED AD-HOC REPORTING >
APPEALS SUPPORT & RESPONSE >
IMMEDIATE REALIZATION OF ROI >
SOLUTIONS FOR ALL PAYOR TYPES >
Why you’LL Like Us.
MeMBeRShIPS & aCCReDITaTIonS
P Phone 877.619.5557
F Fax 801.285.5801
E Email [email protected]
W Web www.hcinsight.com
R HCI Fraud Resources www.profilermag.com www.stophealthcarefraud.com
S Connect With HCI Twitter | Facebook Linkedin | YouTube
M Mail HealthCare Insight 10897 S. River Front Parkway Suite 200 South Jordan, UT 84095
hoW To Contact Us.
© 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 Insight10897 S. River Front ParkwaySuite 200South Jordan, UT 84095
Phone 877.619.5557Email [email protected] www.hcinsight.com
