Intelligent Investigator™ Pinpoint suspicious behavior across all health insurance claims
LexisNexis® Intelligent Investigator™ is an advanced fraud, waste and abuse detection and data mining system that leverages sophisticated rules-based analytics to pinpoint suspicious behavior across all insurance health claims.
An easy-to-use interface allows users to trace potential fraudulent claims by hospitals, members, patients and transactions. The advanced drill-down feature enables any user to quickly obtain a comprehensive patient history snapshot.
With granular insights and ease of data assessment, claims teams can make better informed decisions on the claim in question, helping mitigate fraud, waste and abuse to improve loss ratios.
- Increased understanding of hospital billing patterns
- Easier compilation of data necessary to more efficiently prepare for a case
- Prioritized workflow that looks at both the hospital and claims levels to reduce the number of false positives and that provides “suspicion scores” with transparent explanations to prioritize cases
- Enables non-data experts to identify specific hospital and claims fraud
LexisNexis® Intelligent Investigator™ advanced drill-down feature allows users to trace leads by hospital, members, patients and transaction. Special screens have been built in to assist investigators in identifying hospitals or claims. The user-friendly system also supports usage by non-investigative departments such as hospital relations, medical directors, finance and audit and compliance.
Features include:
- Leverages hospital of Interest Score, a powerful predictive modeling tool that utilizes statistical techniques to identify indicators of fraud, waste and abuse.
- Flexible rules-based structure, with rules that can be easily modified by users as new schemes are detected.
- Promotes a holistic view of hospital, patient and claim data
- Robust ad-hoc reporting system
Contact Us
