Q: Are reports available in electronic format and can I print them?

A: Yes. All reports and result sets from queries return electronic data, which can be printed or saved as files.

Q: Can I enter my own parameters in a search and do real-time analysis?

A: Yes. Intelligent Investigator™ our fraud detection system, and Payment Protector™ our prepayment fraud prevention system, provide an ad-hoc query screen that allows the user to select key fields and enter values to run against the database. These reports augment other routine and automated reports as well as content (columns, headings, etc.) while remaining customizable for each user. When a report has proven to be useful, it may be implemented as an automated report.

Q: Can I export and share reports?

A: Yes. Both Intelligent Investigator and Payment Protector allow for export of results to be saved on a workstation in either Excel or comma-delimited formats. In some cases, a partial export may also be available where certain rows or columns of the result set are selected.

Q: Will the analysis results give me detailed information about the rule violated and information in question?

A: Yes. Analytic reports can give both key data fields data and also descriptive reasons such as a provider frequently exceeds reasonable work hours, provider with a high percentage of a procedure compared to peers in same specialty and provider billing non-emergency procedures on a weekend. These are just some examples of the many descriptions related to our rule set.

Q: How does your system keep up with the latest health care changes?

A: We provide quarterly updates of our fraud rules and schemes as well as new procedures and tests released by AMA and CMS. We have medical consultants and research staff who keep up with developments in the healthcare industry by attending training courses and healthcare conferences. These analysts routinely check with each medical specialty that has a national association to get the latest on the use and acceptability of procedures in their practice. We also purchase healthcare alerts and news bulletins from third parties.

Q: How does your company keep up with the latest in fraud schemes?

A: We use NHCAA certified investigators, attend conferences, discuss needs and current schemes with our customers and prospective customers and subscribe to relevant journals and publications. We also monitor a number of Internet sites for documentation of changes and updates in government rules (including OIG), regulations and healthcare changes. Perhaps the best source of the latest schemes is our account management process that facilitates the customers sharing their newest schemes with us.

Q: We are expanding. How does your company handle our growth?

A: Our solution provides customers with an intuitive user-friendly application that can be used by team members with varying skill levels and analytical experience. Features such as Descriptive Reasons, Automated Analysis, Action Tips and Online Code Look-ups, are designed to accelerate learning and provide the novice user with the knowledge of seasoned investigators.

Q: How do you address the needs of companies to have a consistent presentation of medical information so that different departments can look at the same information but customize their own view? How does EDIWatch achieve that?

A: We apply all of our fraud rules and profiling to all of your claims data. This consistent set of views of data allows for SIU, Claims Processing and Audit functions to be effective at the same time. We also recognize that certain SIU, employee, or other data may not be appropriate for viewing or extracting by all users. Therefore, we have implemented an approach that allows for restricted viewing as well as customized viewing by department, function, or security level.