Provider Scoring Landing Page Upgrades

December 3, 2024

We have implemented several updates to the landing page, modernizing its overall design and functionality. These enhancements include new KPIs, links to intelligence liveboards, and metrics at various levels of granularity, designed to fit varying needs, all aimed at equipping investigators with the tools needed to effectively address provider fraud, waste and abuse.

provider-scoring-landing-page-upgrades

The Client Landing Page is the Liveboard that renders when the “Provider Scoring Insights” tile is selected from within Anti-Fraud Solutions section of the ClaimSearch application.

The new landing page is both a consolidation of some of the existing Intel Options developed over the last couple of years and an expansion that provides new types of medical provider intelligence gathering and prospecting. We think collectively this will make it an effective “home” page from which to conduct detailed provider scoring review and analysis within our Provider Scoring Insights application.

The Liveboard itself is organized across multiple tabs, allowing for various levels of analysis and review to take place depending on varying needs. It’s driven by a wide array of optional filters on which to drill down into the data on demand. Additionally, it’s dynamic such that week over week, the newest data processed will automatically flow into the reporting with no manual intervention required.

Here is a description of each tab that will be part of the new Client Landing Page.

Billing Overview – Evaluate aggregate billing measures and trends along with high level provider scoring and reason code breakdowns. This tab also includes links for easy access to the Providers Page in addition to other configured Liveboards that are purpose-built for exploring various provider behavioral risk patterns.
Top-Down Prospecting – Explore provider billing and treatment trends by jurisdiction, specialty, procedure codes, and more by interacting with various filters and drill-down options. Profile high scoring providers with recent billing based on selected drill-down decisions.
Provider Prospecting – Thoroughly examine specific providers of interest to gain deeper insight into their provider profile, billing patterns, potentials risk factors, and trends.
Patient Treatment Journey – Examine the end-to-end progression of patient treatment such as the order in which various providers were involved in treating the patient and summaries of those service visits.
New Provider Exposures – Monitor new provider entities that have recently started billing your company. Industry aggregated data can help expedite the identification of potential questionable patterns of practice and more quickly spot providers requiring more in-depth analysis and review.
New Provider Risk Indicators – Alert on provider entities that have recently been flagged for new risk indicators involving your medical billing data. Monitor and evaluate risk proactively.
AMD Benchmarking – Compare provider metrics on your carrier data compared to the rest of the Aggregated Medical Database (AMD). Metrics can be sliced across jurisdictions, specialties, procedures, and many more attributes.

With these new upgrades on intelligence, investigators possess a wide range of analytics to drill into based on variable need, and mitigate provider fraud, waste and abuse.

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Provider Scoring Landing Page Upgrades

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