PrePayment Manager™

Identify improper payments before disbursement

LexisNexis® PrePayment Manager™ is an advanced fraud, waste and abuse detection system that works in the prepayment stage of claims processing. The system works across all health care claim types, including medical, facility, pharmaceutical and dental.

Benefits

LexisNexis® PrePayment Manager™ prevents the overpayment of claims without negatively impacting the existing claims processing system that a health care payer has in place. PrePayment Manager never interrupts the claims process because it works with an image of the claim.

Benefits:

  • Higher savings associated with not having to “pay and chase” as a result of daily rules-based screening
  • More effective and defendable investigations due to leveraging rules that have been proven against billing patterns identified in existing claims history
  • Avoid disrupting the claims process by working with an image of each claim rather than the actual claim
  • Comply with prompt-pay laws more easily by applying logic based upon where the claim was filed

Get it now: For more information about LexisNexis® PrePayment Manager™, call 800.869.0751.

Features

LexisNexis® PrePayment Manager™ flags suspicious claims and sends them to Resolution Workbench™, an easy-to-use, built-in automated payment decision tool that allows investigators to release acceptable claims or launch a full-scale investigation of suspicious claims.

Features include:

  • Supports the setup of Patterns and Monitors, which help identify suspect data and the severity of a scheme for better execution of fraud prevention analytics
  • User-friendly interface with actions aligned to client initiatives
  • Full integration with LexisNexis® Intelligent Investigator™
  • Integration with LexisNexis® Resolution Workbench™ automated payment decision tool

Get it now: For more information about LexisNexis® PrePayment Manager™, call 800.869.0751.

Contact Us

For more information about our solutions call 866.396.7703 or contact us online

LexisNexis® PrePayment Manager™ does not constitute a “consumer report” as that term is defined in the federal Fair Credit Reporting Act, 15 USC 1681 et seq.(FCRA). Accordingly, LexisNexis PrePayment Manager may not be used in whole or in part as a factor in determining eligibility for credit, insurance, employment or another permissible purpose under the FCRA. Due to the nature of the origin of public record information, the public records and commercially available data sources used in reports may contain errors. Source data is sometimes reported or entered inaccurately, processed poorly or incorrectly, and is generally not free from defect. This product or service aggregates and reports data, as provided by the public records and commercially available data sources, and is not the source of the data, nor is it a comprehensive compilation of the data. Before relying on any data, it should be independently verified.

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Did you know?

If an improper claim payment is made, health plans have a less than 50% chance of recovering the funds.