Features and benefits
It is important to focus on accuracy as early in the claims process as possible. But you also need to identify and recover errors post payment. We focus our data mining efforts on the root cause of overpayments. This informs our actions on how to change or eliminate the errors in the pre-payment cycle.
We take a macro and micro view of errors and the financial impact based on fully validated recovery files. Our statistical technique identifies situations that are hard to spot at the transactional level. This unlocks significant recovery and prevention opportunities.
For clients who choose to outsource recovery as well as data mining, our process includes:
- Provider communication
- Mail processing
- Appeals management
- Cash recoveries
- Offset recoveries
- Provider refunds
What makes our Data Mining unique?
We use the data we collect to determine how to achieve accuracy earlier in the claims payment lifecycle.
We also have superior data mining results because of our:
- Claims data and recovery experts
- Complex rule logic that includes more than 1,200 algorithms
- Access to more than 9 million industry rules, regulations and policies
- Data intelligence gathered and learned through the large volume of claims we process
Data Mining recovery results
Our results save $1.96 per member per month on average.