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EDIWatch™ provides a unique combination of technologies and processes that enables you to reduce fraud discovery time by as much as 25% in the first year alone. Our rules based system can review every claim as it comes in, not just a random sampling, providing comprehensive profiles to detect new schemes.
Tracking and Reporting
Using our Composite Lead Indicator (CLI), and flagging based on a continually updated rule-set, SIU staff can quickly drill down and target claims that yield a higher probability of recovery. Suspicious cases and provider profiles are combined with historic data and are presented in standard reports. In addition to viewing this information in reports, investigators can also drill down through the case and data with Intelligent Investigator.
Provider Profiles
EDIWatch reviews providers and claims, along with procedure and diagnosis codes, to provide comprehensive profiling. Rule categories include unbundling patterns, upcoding, and over-utilization-often uncovering new schemes in the process. Rules sources include research and analysis, industry experts, AMA, CMS (CCI), and other customers.
Focus on ROI
EDIWatch provides a guaranteed ROI by applying superior technology and improved methodology to insurance claims processing.*
Our solutions provide savings in three major areas:
- Ease of implementation and standardized reporting decreases the burden on IT resources
- Increased SIU productivity focuses existing resources on investigations, not discovery
- Cost savings increase when investigators spend their time doing effective drill-down
Our solutions can be enhanced by our consulting services, as well. This enables you to customize our solution based on your specific business processes, creating additional savings in other areas.
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The level of ROI guaranteed is different for each client and is based on specific client goals, objectives, and parameters. All guarantees are placed in writing after agreement between
EDIWatch and client. |
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