Fraud Solutions Index
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NHCAA's Platinum and Premier Supporting Members are leading providers of products & services to the health care anti-fraud industry, are valued partners who support our mission, and have demonstrated outstanding commitment to the fight against health care fraud. |
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PLATINUM SUPPORTING MEMBERS |
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CGI Federal Inc. Phone: 410.279.0996 |
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CGI, a global IT and consulting company, is an industry leader in identifying improper payments and assisting healthcare payers to control costs. Our Customized Audit System (CAS) includes data mining functionality, algorithms and edits to identify improper payments and other features that increase efficiencies in the audit and recovery process. |
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Emdeon Phone: 877.EMDEON.6 |
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Emdeon EDGE is one of the industry's most complete suites of payment integrity services. Our solutions easily integrate within your existing claims workflow, from pre-payment to post-payment, and provide multi-layered protection that offers both prospective and retrospective claims review, as well as in and out-of-network claims management. Achieve superior claims cost containment and the payment integrity your business needs - how you want it, when you want it. With Emdeon EDGE, when you pay a claim, you can trust it is a claim worth paying. |
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General Dynamics Information Technology Phone: 410.832.8300 |
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General Dynamics Information Technology is a leading provider of healthcare IT, informatics and consulting solutions that help government and commercial health plans improve patient outcomes, enhance market position and reduce costs. |
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HMS Phone: 469.757.0845 |
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| HMS is the nation's leader in coordination of benefits and program integrity services for healthcare payors. HMS's clients include health and human service programs in more than 43 states; product offerings in 49 states and Puerto Rico which include over 200 Managed care plans (Commercial , Medicare, Medicaid); the Centers for Medicare and Medicaid Services (CMS); DOD and Veterans Administration facilities. HMS offers a fully customized, prospective and retrospective FWA solution which integrates into our client's existing workflow and includes forensic behavioral analytics, regulatory compliance maintenance, predictive modeling and provider validation/score carding...and much more. As a result of the company's services, clients recovered over $2.7 billion in 2012, and saved billions of dollars more through prevention of erroneous payments
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LexisNexis Phone: 866.396.7703 |
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LexisNexis gives state/local and federal government agencies as well as commercial health insurance plans the ability to accurately identify potential fraudulent activities among providers, members and claims through comprehensive identity and claims analytics tools. LexisNexis solutions for health care deliver industry-leading data and analytics through a unique combination of identity management solutions, provider data files, and proprietary advanced linking technologies. Our solutions proactively identify emerging problems in claims billing and potential fraud activities before payments are made; improve the payment process by revealing hidden risks undetected by current processes leading to increased cost savings and recovery efforts; and provide support to special investigation units through robust case management and tracking and outsourced SIU support. |
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McKesson Health Solutions Phone: 800.782.1334 |
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McKesson helps payers fight healthcare fraud, waste and abuse all along the payment continuum - from adjudication to pre-pay auditing to post-pay recovery. By combining best-in-class rules content, flexible technology, and predictive analytics in a full service delivery model, we ensure that more abusive or wasteful claims can be stopped in claims operations before they are paid, and that SIU's can recover more fraudulent dollars for less effort. |
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Optum Phone: 800.765.6807 |
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Optum is a health services company with more than 35,000 people dedicated to making the health system work better for everyone. Our solutions and services are used at nearly every point in the health care system, from provider selection to diagnosis and treatment, and from network management, administration and payments to the innovation of better medications, therapies and procedures. |
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SAS Phone: 919.531.9534 |
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SAS is the market leader in providing a new generation of business analytics software and services that create true enterprise intelligence. SAS solutions are used at more than 50,000 sites - including 92 of the top 100 companies on the 2009 FORTUNE Global 500® list. In health care, SAS solutions are used in each of the top 25 health plans and the majority of health care providers - to improve quality of care, productivity, member/staff relations; to enable better and more informed decisions; and to drive organizations forward. The SAS Fraud Framework for Health Care draws on the power of SAS' hybrid approach using rules, anomaly detection, predictive modeling and social network analysis (also called link analysis) techniques in a combined approach to optimize detection. The SAS Fraud Framework is built on a foundation of award-winning data integration and data cleansing. The SAS solution goes beyond typical fraud detection solutions by offering advanced analytics that enable predictive, accurate, prioritized claims decisions before those claims are paid. For nearly three decades, SAS has been giving customers around the world The Power to Know®. To find out more about how SAS can help your organization reach its full potential, visit us at www.sas.com. |
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Truven Health Analytics Phone: 734.913.3432 |
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Truven Health Analytics is dedicated to fighting fraud, waste, and abuse in the U.S. healthcare system. We are a trusted and proven solution provider for numerous payers including government agencies, health plans, and employers. Truven Health delivers unbiased information, analytic tools, benchmarks, and services to the healthcare industry. Our customers have relied on us for more than 30 years. We combine our deep clinical, financial, and healthcare management expertise with innovative technology platforms and information assets to make healthcare better and fight fraud, waste, abuse and overpayment. Our solutions include the application of predictive analytics, network analysis, public records, provider credentialing and surveillance and draws on our extensive algorithm and model library. We collaborate with our customers to uncover and realize opportunities for improving quality, efficiency, and outcomes. We have major offices in Ann Arbor, Michigan; Chicago; and Denver. With broad and deep fraud-fighting experience, Truven Health brings to your organization a high level of expertise and a proven record of delivering results. |
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Verisk Health Phone: 866.269.0238 |
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Verisk Health is the leading provider of real-time, clinically validated payment accuracy solutions. PhysicianClaim Insight is a customizable, sub-second editor that employs over 17 million AMA and CMS rules to deliver the utmost transparency and accuracy. Fraud Finder Pro leverages predictive modeling, link analysis and a proprietary provider-scoring model for complete prevention of fraud, waste and abuse. Each solution is powered by our next-generation software, Nucleus, and leverages our unique clinical validation process. Our doctors, nurses, dentists and SIU teams employ their experience, intellect and intuition to provide the most accurate payment recommendations imaginable. To learn more about our entire suite of payment accuracy solutions, visit www.veriskhealth.com. |
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Verizon Phone: 703.886.2098 |
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Verizon is a global leader in security solutions. Our Fraud Management for Healthcare brings an entirely new approach to healthcare fraud detection, by helping to prevent fraud, waste, and abuse before they occur. 100% of claims are processed and analyzed in near real time, applying domain-specific predictive models, artificial intelligence algorithms and risk scoring to identify and prioritize abnormal patterns indicative of healthcare fraud. Integrated Case Management supports rapid response, first call resolution, and quality monitoring, and workflow management tools and controls help make staff members more efficient and productive. |
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PREMIER SUPPORTING MEMBERS |
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Booz Allen Hamilton Phone: 703.902.5000 |
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Booz Allen Hamilton is a leading provider of management and technology consulting services to the US government in defense, intelligence, and civil markets, and to major corporations, institutions, and not-for-profit organizations. Booz Allen is headquartered in McLean, Virginia, employs more than 25,000 people, and had revenue of $5.59 billion for the 12 months ended March 31, 2011. To learn more, visit www.boozallen.com. (NYSE: BAH) |
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FICO Phone: 1.800.999.2955 |
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FICO delivers superior predictive analytics solutions that drive smarter decisions. The company's groundbreaking use of mathematics to predict consumer behavior has transformed entire industries and revolutionized the way risk is managed and products are marketed. FICO's leading edge fraud detection system helps clients detect more fraud, abuse and error in health care claims before payment and identifies suspicious providers as soon as aberrant behavior patterns emerge. Top insurers rely on FICO solutions to accelerate growth, control risk, boost profits and meet regulatory and competitive demands. |
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Health Care Excel Phone 317.347.4500 |
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Health Care Excel improves health care processes and outcomes by providing expertise in a variety of clinical arenas, focusing particularly on the area of fraud, waste, and abuse prevention. Health Care Excel has over 39 years of experience in program integrity, utilization review, and fraud, waste, and abuse prevention. Leveraging our coast-to-coast teams of clinicians and our state-of-the-art software, Health Care Excel has helped our clients recoup tens of millions of dollars. Additionally, Health Care Excel has worked with the Office of the Inspector General in multiple states to provide audit services for potential fraud and abuse cases. Health Care Excel serves clients in the private sector and in federal and state governments. |
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Healthcare Fraud Shield Phone: 888.333.8140 |
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Healthcare Fraud Shield provides new and unique Fraud, Waste, and Abuse (FWA) automated solutions to the healthcare industry. Our exclusive data solutions and investigative expertise deliver maximum results in the detection and prevention against fraud. Leveraging our comprehensive fraud experience, we deliver fresh insights and new approaches to combat the largest challenge of our time - the delivery of honest, efficient and compassionate healthcare. |
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ID Experts Phone: 866.534.7455 |
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ID Experts is the leading provider of complete data breach solutions, specializing in healthcare privacy incidents. Having served major US healthcare organizations including Cincinnati Children's Hospital Medical Center, Memorial Sloane-Kettering Cancer Center, and CareFirst of Maryland, ID Experts helps prevent and respond to data privacy breaches in a caring, compliant manner. ID Experts is a founding member of the Medical Identity Fraud Alliance (MIFA). |
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Palantir Technologies Phone: 650.815.0200 |
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Palantir Technologies builds software platforms that help human experts perform powerful data analysis at scale. Palantir was initially founded to address the most complex data integration, information analysis, security, and civil liberties challenges faced by the intelligence, military, and law enforcement communities. Since then, Palantir has expanded to help organizations solve problems in health, including Medicaid and insurance fraud, healthcare delivery, disease outbreak tracking and pharmaceutical development. The Palantir Gotham platform is based on the idea that the human mind is the best way to identify patterns in information, while computers are the best tools to manage enormous amounts of data. This approach makes it possible to solve the hardest healthcare challenges in new and innovative ways. |
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Xerox Phone: 770.829.1674 |
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Xerox specializes in population health and administrative management for healthcare programs. We offer a full suite of auditing solutions that help to identify and recover overpayments; detect and stop fraudulent activities; and educate providers to prevent future problems - ensuring that private and public health plan dollars are spent appropriately on patient care. |
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SUPPORTING MEMBERS |
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Rainmakers Strategic Solutions Phone: 443.255.3796 |
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Rainmakers' Program Integrity services focus on preventing and detecting FWA in private, state and federal health care plans and programs. Rainmakers FWA experts deliver innovative and practical solutions in the areas of strategic and tactical planning, design and delivery of processes and computerized tools, outreach and education, and audit support. |
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Thomson Reuters Phone: 800.262.0602 |
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Thomson Reuters is the premier provider of information intelligence across the globe for businesses and professionals. With a wide range of information systems implementation and solution development experience, Thomson Reuters has helped customers detect fraud, waste, and abuse. |
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Verisys® Corporation Phone: 888.837.4797 |
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Verisys® provides health care compliance professionals with the tools they need to prevent waste, abuse, and fraud committed by high-risk people, professionals, and businesses. We are the leading provider of sanctions, exclusions, and disciplinary actions. Our flagship product, FACIS®, offers a full complement of primary sources to monitor licensure, DEA, criminal, sex offender, abuse registries, and more. |
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