LexisNexis®, a Premier Supporting Member of the National Health Care Anti-Fraud Association and the Association of Health Insurance Plans (AHIP) Select Member offers a multi-layered enterprise approach to fraud, waste, and abuse identification and prevention.
Our workflow solutions leverage various public data sources, advanced linking analytics, and predictive analytics in pre- and post-payment environments. The pre-payment models help to identify emerging fraud patterns before adjudicating a claim for services, reducing resources spent on “pay and chase” efforts for commercial payers, and enhancing program integrity concerns for public sector entities.
Our multi-tiered approach touches multiple stakeholder workflows. From tools that assist investigators in their day-to-day investigations to more robust technologies like Social Networking Analytics which reveal hidden relationships and schemes between providers, facilities and patients and expedite the review of claims and investigations.
LexisNexis helps commercial payer organizations make the most of discretionary dollars while at the same time reducing administrative costs included in the calculation of your medical loss ratio requirements. For more information regarding our fraud, waste, and abuse solutions for commercial payers, click here.
In addition to our solutions for commercial payers, we provide fraud, waste and abuse solutions to government health care agencies. Both Medicare and State Medicaid seek solutions to help them navigate through the changing health care landscape more effectively and efficiently. Program integrity must be maintained and improved wherever possible, and fraud and waste across the system must be reduced. For more information regarding our solutions for government health agencies, click here.
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