Medical fraud has become increasingly problematic for property/casualty insurers. This type of fraud, which has recently been a major focus for industry and governing organizations, is at the center of one of ISO’s key new initiatives.
When it comes to evaluating medical bills, insurers are challenged to connect the dots among information contained in claimant histories, medical billing data, and paperwork from providers. These multiple streams of information sources create an environment in which greater and more sophisticated medical billing ploys can flourish. To fight the evolving abuses, ISO created a solution that puts the power back in the hands of individual insurers.
Setting a new standard for medical fraud detection
ISO envisioned a revolutionary new system that would significantly improve the industry’s ability to detect medical billing fraud. That system is ISO MedSentryTM, a solution that integrates advanced predictive analytics with the expertise of clinicians.
Download white paper
Download our white paper entitled Medical Billing Fraud: A New Prescription for a Persistent Problem. You’ll learn how this high-tech, high-touch approach brings accurate, timely, and impactful results to medical billing fraud detection. Its key advantage is that it provides insurers with reliable, specific, and actionable cases. The system helps avoid the problem of following leads that end up being false positives, which can be a huge burden for already time-strapped SIU resources.
The benefits of a combined approach
ISO MedSentry has a one-two punch, combining leading-edge analytics with a human-expert-based validation process. This ensures the cases referred have high accuracy and provability. It offers insurers the critical information needed to conduct faster and more effective investigations and take decisive action on medical provider fraud.
- Faster speed to detection: Sophisticated analytics identify suspicious schemes and providers at the earliest points in the process. Patterns of aberrant treatment and billing behaviors that might otherwise go unnoticed are more quickly revealed.
- Reliable results: With an unparalleled breadth and depth of expertise in its clinical review, clinical analysts weed out false positives so that results are at the highest levels of confidence, as demonstrated by a more than 90 percent referral acceptance rate.
- Actionable cases: During the course of validation, experts prepare documents that include a significant amount of preliminary investigative work so SIU departments can take quick, informed action; prioritize their efforts; and close a greater number of cases.
For more information
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