Provider of Interest Score

Identify aberrant patterns in provider behavior

LexisNexis® Provider of Interest Score analyzes patterns, using predictive modeling, to identify provider fraud that is not highlighted by rules-based systems, by applying statistical techniques to identify combinations of factors that should be analyzed as fraud, waste and abuse indicators.

Benefits

LexisNexis® Provider of Interest Score supports investigators by identifying providers with irregular diagnosis, treatment and billings patterns, highlighting data points where the provider is an outlier from his/her peers, and augmenting data on identified providers with public records such as financial, criminal and medical-sanction derogatory information.

Predictive modeling, as employed by LexisNexis® Provider of Interest Score, utilizes statistical techniques to identify combinations of factors that should be analyzed as fraud, waste and abuse indicators. Scoring then prioritizes results, focusing on areas that have the highest probability of fraud, waste and abuse.

Benefits:

  • Focus efforts in the right places, with false positives reduced by detecting fraud, waste and abuse at the provider level, rather than at an individual claim level
  • Identify patterns of aberrant behavior in providers and uncover indications of emerging fraudulent schemes
  • Optimize claims operations and lower operational costs by accelerating needed investigations and fast-tracking valid claims
Features

LexisNexis® Provider of Interest Score is customized for each organization, taking into account their individual policies and available resources. Models can be based on previously identified fraud, waste and abuse or built without identified problems. Custom models can also address factors such as differences in diagnosis and treatment patterns by geography.

Features include:

  • Adherence to Service-Oriented Architecture standards to minimize the necessity for IT involvement
  • Integration with LexisNexis® Intelligent Investigator™
  • A three-digit score from 100 to 999, with the highest scores equating to higher indications of potential for fraud, waste and abuse, prevention and recovery
More Information
  1. Provider of Interest Brochure

Get it now: For more information about LexisNexis® Provider of Interest Score, call 800.869.0751.

Contact Us

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

LexisNexis® Provider of Interest Score 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 Provider of Interest Score 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?

A McKinsey & Company study found that if U.S. health care organizations were to use big data to drive efficiency and quality, the sector could create more than $300 billion in value every year.