Intelligent Investigator™

Intelligent Investigator™ helps you add vigor and vitality to your health insurance business
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Improve loss ratios by leveraging granular insights and ease of data assessment to enable your claims teams to make better informed decisions faster.

Better risk assessment
Make better informed decisions with a more holistic view of hospitals, patients and claims data insights

Leverage the power of advanced analytics
Sophisticated rules-based analytics help pinpoint suspicious behavior across health insurance claims

Improve loss ratios
Granular insights enable claims teams to be more informed about the claim in question, helping mitigate fraud, waste and abuse to improve loss ratios

Increase convenience and speed
An easy-to-use interface with advanced drill-down features enables users to more quickly obtain a comprehensive patient history snapshot

Benefits

  • Increase your understanding of hospital billing patterns
  • Quickly compile the data necessary to more efficiently prepare for a case review
  • Prioritized workflow that looks at both the hospital and claims levels to reduce the number of false positives and that provides “suspicion scores” with transparent explanations to prioritize cases
  • Enables non-data experts to identify specific hospital and claims fraud

Features

LexisNexis® Intelligent Investigator™ advanced drill-down feature allows users to trace leads by hospital, members, patients and transaction. Special screens have been built in to assist investigators in identifying hospitals or claims. The user-friendly system also supports usage by non-investigative departments such as hospital relations, medical directors, finance and audit and compliance.

  • Leverages Hospital of Interest Score, a powerful predictive modeling tool that utilizes statistical techniques to identify indicators of fraud, waste and abuse.
  • Flexible rules-based structure, with rules that can be easily modified by users as new schemes are detected.
  • Promotes a more holistic view of hospital, patient and claim data
  • Robust ad-hoc reporting system

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