PharmaClaim Insight®

PharmaClaim Insight®, from Verisk’s HealthCare Insight (HCI) unit, is a service that helps prevent fraud, abuse, and overpayment for pharmacy and medical claims. The service examines claims retrospectively. We’ve designed PharmaClaim Insight to maximize claims-payment accuracy, identify fraudulent activity, and reduce the cost of pharmacy claims.

PharmaClaim Insight combines:

• HCI’s Code Validator Pro® (rules-based) and Fraud Finder Pro® (profiling) software systems
• claims-repricing software systems
• claims review by clinical experts
• review of suspect billing by a Clinical Investigative Unit (CIU)SM

You get improved reserves and greater efficiency in identifying fraud.

For more information . . .
. . . about PharmaClaim Insight, visit the HealthCare Insight website, call us at 1-800-357-7781, or send e-mail to This e-mail address is being protected from spam bots, you need JavaScript enabled to view it