A PRIVATE-PUBLIC PARTNERSHIP AGAINST HEALTH CARE FRAUD
NHCAA’s Platinum, Premier and Standard 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.
Download the Anti-Fraud Solutions Guide for more information on NHCAA Supporting Members.
2333 San Ramon Valley Blvd.San Ramon, CA 94583
Phone: 925.217.4550Email: info@4LData.comWebsite: 4ldata.com/
4L Data Intelligence™ is the Integr8 AI™ powered company focused on helping our customers and partners deliver better healthcare, insurance and government services at a lower cost by improving data, provider, payment and decision integrity. We are committed to USING THE POWER OF INTEGR8 AI™ TECHNOLOGY FOR GOOD by helping healthcare payers, health systems, governments and insurers deliver better services and care and reduce trillions of dollars in out-of-control costs by making actionable data accessible in real-time, automating inefficient processes and preventing fraudulent, wasteful and abusive payments that drive up costs. For more information visit 4LData.com.
400 TradeCenter, Suite 5900Woburn, MA 01801
Phone: 617-227-5111Email: firstname.lastname@example.orgWebsite: www.aliviaanalytics.com
Alivia Analytics is the industry leader providing solutions that are revolutionizing healthcare payment integrity. Boasting the lowest false positive rates in the industry, Alivia Analytics delivers unprecedented speed, accuracy and usability. Integrated case management, user-friendly dashboards, simple data ingestion and flexible workflows put new power in the customers’ hands. By designing technology that adapts to existing business processes, healthcare payers can rapidly generate more confident outcomes and realize greater ROI. Let’s achieve healthcare payment integrity, finally.
2405 Commerce Ave NW, Suite 500Duluth, GA 30096
Phone: 470-223-3592Website: http://www.codoxo.comEmail: email@example.com
10701 S River Front PkwyUnit 200South Jordan, UT 84095Phone: (770) 379-2800Email: firstname.lastname@example.orgWebsite: cotiviti.com/solutions
Payment integrity leadership requires experience, scalability, innovation, and proven value. Cotiviti has spent 20+ years honing our solutions specifically to drive exceptional value for our clients all along the claim payment life cycle — from prospective payment policy management and clinical coding review to both pre and postpay chart review and fraud investigation. We help clients work more effectively across their payment accuracy silos by deploying the right approach at the right time, driven by a full-service model and the deepest industry expertise.
320 Park Avenue29th FloorNew York, NY 10022Phone: 212.277.7100Website: https://www.exlservice.com/healthEmail: email@example.com
EXL Health combines deep domain expertise with analytic insights and technology-enabled services to transform how care is delivered, managed, and paid. Applying our expertise in AI, analytics and cloud, we make sense of your health-related data, enabling you to improve outcomes, optimize revenue, and maximize profitability across the care continuum. Our digital dexterity and Human Ingenuity are the catalysts to solve complex healthcare problems. With data on more than 260 million lives, we work with hundreds of organizations across the healthcare ecosystem. EXL’s proprietary Payment Services analytics platform and digital first analytics support our clients in maximizing reimbursement and ensuring payment integrity. To learn more visit https://www.exlservice.com/health.
Healthcare Fraud Shield was founded in 2011 to offer innovative fraud, waste, and abuse (FWA) solutions to the healthcare insurance industry. The focus of Healthcare Fraud Shield is solely on healthcare fraud prevention and payment integrity with a successful approach based on many unique advantages we deliver to our clients.
Healthcare Fraud Shield’s fraud, waste, and abuse software as a service platform – FWAShield™ – is an integrated solution consisting of PreShield™ (pre-payment), AIShield™ (AI), PostShield™ (post-payment), RxShield™ (pharmacy analytics), QueryShield (ad hoc query and reporting tool) and CaseShield™ (case management).
FWAShield™ was developed by industry leading healthcare subject matter experts with the latest technology available today to provide the most affordable, flexible, transparent, efficient, and effective solution in the marketplace.
199 Water Street, 27th Floor, New York, NY 10038Phone: 734-262-0242Website: https://www.medreview.us/
“Physician Approved Payment Integrity” makes MedReview a different type of payment integrity firm. Our doctors review, approve and document every claim we reassign providing our clients with the lowest appeal overturn rate in the industry. This focus on clinical quality returns the highest savings per review.
MedReview delivers Pre-Payment and Post-Payment DRG, Hospital Bill Audit, and Readmission reviews and audits. As a part of the solution, our proprietary selection algorithm delivers a targeted selection resulting in a 40% or greater reassignment rate. MedReview is proud to work with three (3) of the top five (5) largest health plans in the US.
115 Fifth AvenueNew York, NY 10003Phone: 866.750.7427Email: firstname.lastname@example.orgWebsite: https://www.multiplan.us/
MultiPlan offers a total healthcare cost containment solution that includes payment and revenue integrity, network-based and analytics-based services, helping payers reduce the cost of care and improve competitiveness. Unlike similar products, MultiPlan’s payment integrity services include a personal review by an experienced clinician in addition to automated reviews. This human touch allows us to catch more complex issues indicative of waste and abuse, that go undetected by other products. For over 40 years, we’ve processed claims prepayment. Today more than 1 million providers participate in our networks, partnering with us to control claim costs. Our rich history helps us resolve payment integrity issues quickly while minimizing provider abrasion – all before our clients pay a dime.
11000 Optum CircleEden Prairie, MN 55344Phone: 800.765.6807Website: www.optum.comEmail: email@example.com
At Optum, we are a leading health services innovation company dedicated to helping make the health system work better for everyone. We create simple, effective and comprehensive solutions for organizations and consumers across the whole health system by integrating our foundational competencies of consumer experience, clinical expertise, data and analytics, and embedded technology into all Optum services. By understanding the needs of our customers, members and patients and putting them at the center of everything we do, we will achieve our aspiration of improving experiences and outcomes for everyone we serve while reducing the total cost of care.
100 SAS Campus DrCary, NC 27513Phone: 919.677.8000Email: firstname.lastname@example.orgWebsite: www.sas.com/fwa
SAS is the leader in advanced analytics software and services, and the largest independent vendor in the business intelligence market. With SAS® payment integrity solutions, health care organizations can detect suspicious activity, prevent improper payments, and uncover collusion and multiparty fraud schemes. Since 1976, SAS has given customers around the world THE POWER TO KNOW®.
321 Summer Street, 7th FloorBoston, MA 02210Phone: 817-456-9229Website: www.shift-technology.comEmail: email@example.com
Shift Technology delivers AI decisioning solutions to benefit the global insurance industry and its customers. Our products enable insurers to automate and optimize decisions from underwriting to claims, resulting in superior customer experiences, increased operational efficiency, and reduced costs. The future of insurance starts with Decisions Made Better. Learn more at www.shift-technology.com.
500 North State College BlvdSuite 900 Orange, CA 92868Phone: 610.727.7000Email: firstname.lastname@example.orgWebsite: www.amerisourcebergen.com/
AmerisourceBergen is a leading global healthcare solutions company. The company drives innovative partnerships with pharmacies, health systems, practices and manufacturers to improve product access, increase supply chain efficiency and enhance patient care. Customers count on AmerisourceBergen for comprehensive services and solutions across the healthcare supply chain – from commercialization and distribution to pharmacy, health system, practice and manufacturer solutions. The company’s extensive knowledge, global reach and innovative partnership philosophy enable them to help customers capitalize on the dynamic changes in healthcare. With more than $120 billion in annualized revenue, AmerisourceBergen is the leader in global sourcing and distribution and employs approximately 16,000 employees worldwide from their headquarters in Conshohocken, PA. AmerisourceBergen. Where knowledge, reach and partnership shape healthcare delivery. For more information, visit www.amerisourcebergen.com.
1001 Lakeside AvenueSuite 800Cleveland, Ohio 44114-1151Phone: 410.279.0996Website: www.cgi.com/healthcareEmail:healthcompliance_BD@cgifederal.com
CGI, a global IT and consulting company, is an industry leader in identifying improper payments and assisting healthcare payers to control costs. Our fraud, waste and abuse solution, ProperPay, includes data mining functionality, algorithms and edits to identify improper payments and other features that increase efficiencies in the audit and recovery process.
710 Johnnie Dodds Blvd Suite 100Mt Pleasant SC 20464Phone: 866.225.6447Website: www.claimlogiq.comEmail: Scott.Strent@ClaimLogiq.com
ClaimLogiq is a healthcare software and technology company that delivers a proactive approach to payment integrity through a powerful, simplified solution. The unique payer-facing, claim-analyzing solution is HITRUST CSF® certified and makes claims accessible to all size healthcare payers for in-depth insight and real-time access into the status of every claim at every stage of the audit lifecycle for controlled, consistent, accurate, and defensible outcomes, second to none. ClaimLogiq’s innovative software stands out from the crowd by allowing payers client-driven control, customizability, and total transparency over the entire claim process and can be applied as a SaaS model, full services, or as a hybrid to suit the specific needs of every payer and provider agreement. ClaimLogiq’s groundbreaking technology produces more cost savings and all-but-removed provider abrasion, impacting millions of lives annually in the pursuit of a higher quality of healthcare for all. For more information, visit www.claimlogiq.com or follow ClaimLogiq on LinkedIn.
301 Plus Park Blvd Ste 210Nashville, TN 37217-1036
ClarisHealth is the answer to the health plan industry’s siloed solutions and traditional models for identification and overpayment recovery services. We provide health plans and payers with total visibility into cost containment operations through our one-of-a-kind advanced technology platform Pareo®. The Pareo Fraud solution is an A.I.-powered web-based platform for investigators, SIU leaders and other areas of a healthcare payer’s Payment Integrity operation to detect, create, manage, process and report on leads and cases that are potential fraud, waste, abuse and general overpayments. The solution easily integrates with ClarisHealth’s Total Payment Integrity solution suite. As a standalone offering, Pareo Fraud helps SIUs and its investigators become more efficient in their day-to-day activities, better monitor the success and ROI of the unit, and improve the decisioning time for improved recoveries.
1012 14th Street, NW Suite 1105Washington, DC 20005Phone: 202-393-7330Email: info@InsuranceFraud.orgWebsite: www.InsuranceFraud.org
Founded in 1993, the Coalition Against Insurance Fraud is a nonprofit alliance of consumer groups, insurance companies, government agencies and other partners combating all forms of insurance fraud through advocacy, public education and research. The Coalition has more than 210 member organizations.
55 Shuman Blvd., Ste 650Naperville, IL 60563Phone: 800-783-3378Website: www.context4healthcare.com
Context 4 Healthcare is the leading provider of cloud-based healthcare compliance solutions in verifying medical claim accuracy for health plans and benefits administrators. These solutions are designed to review for complex coding accuracy, identification of potential fraud, waste, and abuse (FWA) situations before the claim is paid, and to review for potential FWA situations in claim history. Context’s Medical Director and our team of certified claim experts maintain solution rules weekly for up-to-date compliance and identification of potential new FWA schemes. The semi-annual creation of our proprietary UCR fee schedules is also a source for identifying potential FWA situations leading to new solution rules, a capability unique to Context. Our experts also blog for your benefit, letting you know about emerging situations that may affect your compliance, and what Context is doing about it. Since 1988, Context has been the healthcare industry’s leading compliance specialist.
2000 Purchase Street Purchase, NY 10577-2509Phone: 914.249.2509Website: www.mastercard.com
Mastercard Healthcare Solutions provides a proven AI solution that differentiates by leveraging its experience in payment fraud to complement claim fraud mitigation. Mastercard Healthcare Solutions’ unique competency supports post-pay detection, while also creating prospective (pre-pay) models built by identifying anomalies found in historical claims data (post-pay). In this webinar, you will learn how you can increase detection of fraud, waste and abuse (FWA) before sending good money for bad claims, significantly reducing inefficient pay-and-chase activities while moving toward a prevent and save business model. With increased detection of true FWA, false positives are greatly reduced, anomaly detection is significantly increased, and payers can focus their investigators’ time on highly-likely FWA.
202 Burlington RdBedford, MA 01730-1407Phone: 781.271.2000Website: http://mitre.org/
MITRE is a not-for-profit organization that operates research and development centers sponsored by the federal government.
We operate FFRDCs-federally funded research and development centers-which are unique organizations that assist the United States government with:
We also have an independent research program that explores new and expanded uses of technologies to solve our sponsors’ problems.
MITRE’s Sole Focus Is to Operate FFRDCs
MITRE is chartered to work in the public interest. We have no commercial interests. We have no owners or shareholders, and we can’t compete for anything except the right to operate FFRDCs. This lack of commercial conflicts of interest forms the basis for our objectivity. We also have the ability to acquire sensitive and proprietary information from the government and industry to inform our work. These organizations are able and willing to share data because they know we won’t use it for a competitive advantage.
Moreover, because we operate multiple FFRDCs, we foster a culture of knowledge sharing. We apply what we learn from addressing one sponsor’s challenges to similar issues faced by other federal agencies. This means when sponsors engage with us, they have access to all the minds of MITRE.
Nokomis was founded in 2013 to ensure Claim Accountability in the healthcare system. Nokomis CEO, Rich Henriksen, has a deep knowledge of claims reimbursement and contracting. Through 35 years in healthcare, he pieced together his complex learnings and understandings in the claims space and realized there was a more efficient, effective, and accurate way to ensure Claim Accountability in the industry, in a way that is seamless for health plans to implement. This Nokomis experience not only saves an average of 10% on the claims that Nokomis reviews, but claims also are returned in one business day. Plans pay only on a percentage of realized savings and there are no fees or minimums. Nokomis works alongside other review systems that plans might already have in place in order to find incremental savings – especially since there is no minimum claim size for Nokomis and 100% of claims are reviewed. The Nokomis team has been in the shoes of a health plan and understands the nuances involved in creating an easy partnership.
1001 N. Fairfax AveSuite 640Alexandria, VA 22314Phone: 888.837.4797Website: www.verisys.comEmail: email@example.com
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.
NHCAA offers membership categories for health insurers, governmental entities, and other companies and organizations that support the NHCAA Mission, as well as individuals, who want to join us in the fight against health care fraud.
Platinum & Premier Supporting Members
National Health Care Anti-Fraud Association Headquarters
1220 L Street, NW, Suite 815 | Washington, DC 20005 | Phone: 202.659.5955 | Fax: 202.785.6764