Insight and Discovery Portal™

An intuitive portal for payers that enables quick identification of potential fraud, waste, and abuse (FWA) through interactive exploration of their paid claims data.

Intuitive and Interactive FWA Detection

Reduce the cost of FWA identification by avoiding the need for extensive development, data manipulation, custom reporting, or output analysis.

View, focus, and examine paid claims data through an intuitive interface with drill-down functionality and interactive analysis.

Quickly identify leads using real-time search, various filters and measures from multiple scoring models and peer group analysis.

Track payment trends for providers, procedures, and diagnoses through graphic, enterprise-wide views that quickly highlight outliers.

Identify Outliers and Trends through Instant Access to Paid Claims Data

Discover Outliers and Assess Billing Behavior

  • Measure providers against their peers through scores that use financial and frequency ratios which can identify possible up-coding, unbundling, and billing for services not rendered.
  • Identify outlier providers within peer groups and understand level of deviation for procedures and diagnoses not captured by established business rules.
  • Review scores pulled from multi-payer models that score claims from approximately 60% of the U.S. population.

Identify Payment Trends and Risks

  • Identify spikes in payment and billing trends for providers, procedures, and diagnoses and illuminate potential network opportunities.
  • Examine relative risk scores for providers who have been paid significantly more than their peers for a selected procedure or diagnosis.
  • Review the highest paid providers by procedure and diagnosis and identify providers billing outside the norm for their peer group.

Intuitive Interaction for Customized Analysis

  • Interact with paid claims data through provider, procedure and diagnosis centric views.
  • Drill into paid claims data using real-time search and filters such as paid dollars, scores, state, or specialty.
  • Using an interactive tree map, easily visualize and adjust the view of your paid claims data through multiple group, size and color options.

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