Claims Solutions

Provider Scoring

Quickly discover fraud schemes in your book of business with Provider Scoring™, an advanced lead-generation tool that leverages aggregated industry data and predictive analytics.

Demo Provider Scoring

Improve your loss ratio and reduce loss adjustment expenses

Medical fraud, waste, and abuse cost insurers at least $80 billion each year. Medical expenses associated with bodily injury claims are one of the leading drivers of allocated loss adjustment expenses (ALAE). Does your SIU team have the information they need to fight medical billing fraud?

Unlock ROI and long-term benefits

Provider Scoring provides a range of ROI metrics to support your success in the first year, champion your achievements, and ensure continued long-term benefits.

Hit the ground running with greater insights

SIU investigators get qualified leads backed by specific issues so they can devise investigative plans, launch factual examinations, and develop questions for interviews, examinations under oath, and depositions.

Detect and deliver better analytical leads

Provider Scoring analyzes massive amounts of providers to spotlight outlier trends and patterns of practice, including high exposures and emerging schemes, so SIU analysts can identify which providers to focus on in their book of business.

Get significant ROI from actionable leads

With leads vetted simply and quickly, teams will know which providers to investigate and why, and SIU managers can articulate ROI with several tangible success metrics.

Save time, reduce expense, realize ROI

Achieve return on investment in the first year and beyond with several different metrics:

Reduce analytical and investigative cycle times

Increase loss avoidance

Improve quality of referrals

Robust data powers deep analysis

Medical Provider Scoring doesn’t stop with your data. It analyzes data from the Aggregated Medical Database—the largest P&C billing data repository.

2M+ providers
5M+ patients
$47B+ billing financial exposure

Robust data powers deep analysis

Features and capabilities

Increased FWA detection

Provider Scoring uses more than 100 advanced analytic models, casting a wider net to find more fraud, waste, and abuse (FWA).

Core referral metrics

Get insights on which providers may be submitting questionable bills and specific reasons the providers triggered potential FWA issues.

Financial impacts of FWA on your business

See projected patient counts and estimated dollar amounts billed by highlighted providers for each triggered reason, as well as benchmarking of the provider’s total billings among their specialty peers.

Related resources

Learn more about how to uncover medical provider fraud.

Case study

Major P&C insurer uncovers medical provider fraud with innovative analytic solution.pdf

Learn how a top 10 insurer used medical provider scoring to uncover over $170K in questionable bills from a physical therapy practice.

Download the case study

Brochure

The analytics and insights you need in a workflow built for speed

Carriers primarily face two challenges in detecting suspicious billing activity: finding which providers are submitting questionable bills and determining what specifically is questionable in the bills.

Download the brochure

Article

Spotting the unseen menace: Medical provider fraud, waste, and abuse

Although the insurance industry is constantly plagued by suspicious claims activity, the unseen menace that’s leading to diminished profits is medical provider fraud, waste, and abuse.

Read the article

Do more with the Verisk ecosystem

Provider Scoring is part of a full suite of claims solutions that provide compliance, claims development, and deeper fraud analysis and tools.

The world’s largest P&C claims database

Fast-track claims while improving fraud detection with access to data from more than 1.7 billion claims.

Learn about ClaimSearch

Missing details to complete claims

Get hundreds of supplemental data reports to enhance claim analysis and investigations.

Learn about Research Hub

Colleagues Viewing Solutions On Multiple Displays

Claim scoring through predictive analytics

These models deliver enhanced claim scores and reason codes to detect potential fraud and support investigations.

Learn about Claim Scoring

Fraudulent images in claims identified

This automated process applies a series of algorithms to every customer-submitted loss photo to expose anomalies.

Learn about Digital Media Forensics

Workers Viewing Coordinates On Multiple Screens

Advanced link analysis to fight organized insurance fraud

Discover the hidden relationships and connections among claimants, providers, and businesses.

Learn about Network Analysis

Contact us to learn more

We are available Monday through Friday, 7 a.m. — 8 p.m. US Eastern Time:

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Note that password resets and user information are not available through Live Chat or Email. Instead, please call the main toll-free number below.

Main toll-free:

1-800-888-4476

Global toll-free:

International Access code, then 800 48977489
When calling from the UK, please dial 00 800 4897 7489

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