Provider Integrity Scan

Know your providers, reduce risk, and prevent fraud.

LexisNexis® Provider Integrity Scan automates a variety of provider verification searches and ongoing monitoring options, and provides automatic red flag alerts for a wide range of high risk indicators.

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

Customers benefit from: Speed. LexisNexis standard turnaround time for practically any size batch is approximately 24 hours. For requests of 5,000 or less, turnaround times are usually between one and two hours.

Efficiency through processing power. LexisNexis Provider Integrity Scan provides massive scalability, and leverages LexID®, our advanced data-linking technology to drive efficiency and confidence in the results it returns. LexisNexis standardizes and normalizes data utilizing over 100,000 rule sets for address hygiene, name matching and the identification of mis-keyed data and other anomalies. The result is data that is current, policy compliant and immediately useful to the customer.

Comprehensive data or breadth of LexisNexis public records catalogue of data. LexisNexis is the world leader in providing comprehensive, authoritative and reliable information for effective decision-making and draws from almost 44,000 sources of records to maintain a master identity repository contains over 252 million unique domestic identities, enabling customers to leverage the largest collection of identifying information in the US. LexisNexis also employs a variety of best practices and innovative processes for data cleansing and management to enhance the effectiveness of these data sets, including standardization and normalization of that data.

Trust in our industry leading data security. When you work with LexisNexis, you can rest assure that your data is secure and is never shared.

Superior customer service. We are committed to providing prompt, friendly and useful customer service. We will provide your organization with designated support representatives to help you through the process, answer questions and offer suggestions on how to get the most out of your data files.

Get it now: For more information about LexisNexis® Provider Integrity Scan, call 800.869.0751.

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.

Features include:

  • Result delivery via batch or XML
  • Ability 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
    • Sanctions
    • Criminal convictions
  • High risk indicators for address and SSN
  • Financial information such as liens, bankruptcies and judgments
  • Provider business ID verification

Get it now: For more information about LexisNexis® Provider Integrity Scan, call 800.869.0751.

Literature

  1. LexisNexis® Provider Integrity Scan - Commercial
  2. LexisNexis® Provider Integrity Scan - Government

Get it now: For more information about LexisNexis® Provider Integrity Scan, call 800.869.0751.

Contact Us

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

LexisNexis® Provider Integrity Scan 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 Provider Integrity Scan 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?

If an improper claim payment is made, health plans have a less than 50% chance of recovering the funds.