Payment Integrity

Capture more revenue to reduce inappropriate claims payment

Industries /Healthcare & Life Sciences /Health Plans /Payment Integrity

Maximise Revenue With Proven Toolsets

In today’s complex health plan environment, you must analyse huge data loads, coordinate payments to multiple carriers and manage a wide range of health plans across government and commercial clients. This makes payment integrity issues, including fraud, waste and abuse (FWA), more common. FWA leads to higher costs for you – and higher co-payments and premiums for members. NTT DATA can help. Along with our strategic partners, we deliver solutions that use workflow automation and dashboards to help you proactively detect and investigate non-payable claims.

We can help you capture more revenue and automate payment authorisations with proven toolsets for screening, scoring and coordinating benefits. Our solutions allow you to improve pre-pay screening and scoring for direct savings and scan for programme irregularities and billing anomalies. Plus, you can use advanced analytics to improve audit and recovery results and increase referrals using provider risk scorecards. Let’s get started.

Reduce Inappropriate Claims Payments Before They Happen

Our approach to health plan payment integrity solutions helps you proactively detect fraudulent claims with proven toolsets for screening, scoring and coordinating benefits so you can improve payment integrity.

SIMPLIFY

Automate coordination of benefits with other carriers to verify eligibility, coverage, coding

COMPLY

Keep on top of changing federal and state regulatory mandates

RESPOND

Dynamic reporting of multiple performance indicators through automated workflow, dashboards

PROTECT

Implement effective detection, investigation, recovery services

Our Services

Claims Editing Platform

Evaluate claims for coding accuracy and integrate with claims workflow processing in real time, without human intervention.

Coding/Clinical Error Identification

Validate claims data using the platform and clinical analyst to identify inconsistent or incorrectly coded claims.

Consulting & Integration

Ongoing support and subject matter expertise to analyse existing or needed systems for client-specific business process management solutions.

Coordination of Benefits

Streamline recovery for commercial and government plans by using a 360-degree member review and innovative combination of unique algorithms and information from non-conventional data sources.

Overpayment Identification

Review paid claims files and apply data mining/grouping logic/algorithms to identify potential overpayments and provide insights into disbursement leakages.

Subrogation

Orchestrate accurate recovery and payments from a variety of information sources through improved data mining and billing.

We can help you capture more revenue and automate payment authorisations with proven toolsets for screening, scoring and coordinating benefits.

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