Today’s government and commercial health care market is in a constant state of change. Both government agencies and private insurers need to bring value through more effective claims, clinical targeting and revenue optimization. And payers are looking for a single-source system that delivers an innovative, broad spectrum of services to fill gaps in their existing processes and improve outcomes.
During this session we’ll look at a payment integrity approach that delivers results. We’ll also share case studies to show how you can use analytics to create measurable financial impact for both government and commercial payers and providers.
We’ll review four key disciplines, including:
- Data management. Getting internal and external data into shape so you can use enterprisewide analytics, reporting and results management.
- Claims analytics. Learning whether a claim is properly submitted and should be paid.
- Behavioral analytics. Using modern analytic techniques to identify true fraud and derive the greatest lift.
- Clinical targeting. Identifying where and when waste and abuse might be happening.
Ricky D. Sluder, CFE
Enterprise Fraud and Data Analytic Subject Matter Expert