ISO MedSentry

ISO MedSentry® is the industry standard for fighting medical provider fraud. As part of the ISO ClaimSearch® portfolio, ISO MedSentry uses Software-as-a-Service (SaaS) technology to provide a flexible, accurate, and quick solution for detecting fraud, waste, and abuse in medical billing data. By combining sophisticated data analysis with expert clinical review, ISO MedSentry:

  • supports the work of special investigation units (SIU), medical management, and claims teams
  • eliminates false positives
  • saves insurers significant time and money

How does ISO MedSentry work?

Using the insurer’s medical provider history and weekly incremental files, ISO MedSentry begins an investigation of provider billing data by applying automated analytical tools to identify possible suspect providers. Suspect cases are then sent for expert clinical analysis.

ISO MedSentry compiles the information as a referral for the insurer’s team(s) to download and review. It’s that simple.

Get started

Contact Shane Riedman to learn more about how easy it is to integrate ISO MedSentry into your workflow.

 
RESOURCES

White Paper
Each year, more than $400 billon is lost to healthcare fraud, waste, and abuse. Property/casualty losses are estimated at $24 billion per year. Download the white paper to learn why.

Case Study
ISO MedSentry provides a direct return on investment between 10:1 and 20:1. Customers report that clients reduced medical billing by 71% on average, with billing reductions of 69% from suspect providers after encounters with insurers’ SIU teams Download a case study to see how carriers use ISO MedSentry in their operations. Or contact Shane.Riedman@verisk.com to discuss how this solution could help you.