LexisNexis® Provider Integrity Scan is designed to help reduce health care payers' costs by identifying potentially fraudulent providers and businesses enrolled or attempting to enroll in health-related programs. Our solution gives users the ability to efficiently process multiple searches and obtain critical information contained within massive volumes of data from verification of data to risk scoring and fraud indicators
- Ensure that only trustworthy professionals provide care in their network through verification of crucial information that is currently self-reported
- Automate enrollment processes through streamlined verification of documents, with consolidation of numerous checks. Utilizing its industry-leading data assets and sophisticated matching capabilities, LexisNexis is able to resolve identities with confidence. We offer multiple delivery channels to minimize changes to current workflow process and improve overall efficiency
- Comply with CMS mandates that Medicare, Medicaid and CHIP providers be screened for their risk of committing FWA before being allowed to enroll in federal programs
LexisNexis® Provider Integrity Scan leverages advanced data technology to assist health care payers in both the private and public sectors in verifying and monitoring health care provider licensing and credentials, and detecting and preventing fraudulent or criminal provider activity.
- Result delivery via batch or XML
- Ability to process multiple searches and obtain the critical information contained within massive volumes of data.
- Provider information and credentials and alerts including:
- Deceased information with date of death
- Provider file monitoring for risk indicators between enrollment periods.
- License status
- Criminal convictions
- High risk indicators for address and SSN
- Financial information such as liens, bankruptcies and judgments
- Provider business ID verification
Cleints & Testimonials
With Provider Integrity Scan, LexisNexis has already helped a number of states (four as of May 2013) comply with the ACA standards for provider screening. In a recent LexisNexis analysis of a Medicaid Managed Care file:
- Over 1% of providers were deceased
- 1.7% of providers were sanctioned
- Incarcerated individuals were active providers