Intelligent Investigator™

Pinpoint fraud with confidence

LexisNexis® Intelligent Investigator™ is an advanced fraud detection system built exclusively for health care payer investigative teams.

LexisNexis® Intelligent Investigator™ is a highly engineered fraud-detection system that pinpoints patterns of suspicious behavior across all health care claim types, including medical, facility, pharmaceutical and dental. With its easy-to-use Graphical User Interface (GUI), Intelligent Investigator uses comprehensive analytics from industry experts to effortlessly walk users of all levels through potentially fraudulent cases in order to uncover actionable findings.

Clients benefit from:

  • Increased understanding of provider billing practices
  • Easier compilation of data necessary to more efficiently prepare for a case
  • Prioritized workflow that looks at both the provider and claims levels to reduce the number of false positives and that provides “suspicion scores” with transparent explanations to prioritize cases.
  • Enablement of non-IT experts to target specific providers and claims based on incomplete data

Get it now: For more information about LexisNexis® Intelligent Investigator™, call 800.869.0751.

LexisNexis® Intelligent Investigator™ advanced drill-down feature allows users to trace leads by provider, member/patient, transaction and other related data with ease. Special screens have been built in to assist investigators in identifying providers or claims based on partial information or tips off fraud hotlines. The user-friendly system also supports usage by non-investigative departments such as provider relations, medical directors, finance and audit among others.

  • Flexible rules-based structure, with rules that can be easily modified by users as new schemes are detected.
  • Leverages Provider of Interest Score, a powerful predictive modeling tool that utilizes statistical techniques to identify indicators of fraud, waste and abuse.
  • Leverages Composite Lead Indicator (CLI) a proprietary indexing tool that prioritizes the potential savings and recovery probability of each lead in order to establish the recommended index order.
  • Promotes a holistic view of patient, claim and pharmacy data
  • Robust ad-hoc reporting system

Get it now: For more information about LexisNexis® Intelligent Investigator™, call 800.869.0751.

Contact Us

For more information about our solutions call 800.869.0751 or contact us online

LexisNexis® Intelligent Investigator™ does not constitute a “consumer report” as that term is defined in the federal Fair Credit Reporting Act, 15 USC 1681 et seq.(FCRA). Accordingly, LexisNexis Intelligent Investigator may not be used in whole or in part as a factor in determining eligibility for credit, insurance, employment or another permissible purpose under the FCRA. Due to the nature of the origin of public record information, the public records and commercially available data sources used in reports may contain errors. Source data is sometimes reported or entered inaccurately, processed poorly or incorrectly, and is generally not free from defect. This product or service aggregates and reports data, as provided by the public records and commercially available data sources, and is not the source of the data, nor is it a comprehensive compilation of the data. Before relying on any data, it should be independently verified.

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Did you know?

The National Health Care Anti-Fraud Association estimates that between 3–10 percent of what Americans spend annually on health care is lost to fraud and abuse.