Commercial Payers
We understand the delicate balance that payers face when dealing with improper payments resulting from fraud, waste and abuse, while still maintaining a relationship with providers to meet the needs of your members. Commercial or provider owned payer organizations with Medicaid, Medicare, Federal Employee Health Benefits, and other lines of business benefit from our expertise in building, maintaining and supporting an effective program to identify, investigate and prevent FWA.
Our support includes:
Outsourced investigative and medical review services
New case development and data analysis
Statistically valid random sampling (SVRS) and extrapolation
FWA program and annual work plan development
In-depth assessments of SIU operations with executable action plans
Payment integrity services
Compliance and regulatory support
Education and training
There are so many nuances to being a health payer. Trust the experts who know your business to help you.