Fraud Management Solution

Insurance fraud detection in healthcare involves analyzing claims for misleading or false information to get payers to reimburse ineligible medical procedures. Numerous insurance payers often use fraud management solutions to streamline and automate parts or entire investigative processes to filter out and flag suspicious claims. Investigating each claim manually is not only slow and tedious but not efficient, as an average payer is likely to deal with hundreds or even thousands of claims each day. In light of this, a reliable fraud management solution saves time and revenue.     

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Our fully-integrated and browser-based fraud software offer comprehensive functionality for predictive fraud detection in healthcare. At OSP, we create predictive data analysis that encompasses advanced analytics techniques, like statistics, text mining, data mining, and decision support engines. Our healthcare fraud software analyzes the complex and interrelated relationships among thousands of data sets to provide a potential fraud occurrence. We create medical fraud management systems that employ memory-based reasoning to identify similar cases from experience. It applies the collected information from these cases for in-depth classification and prediction. The memory-based reasoning applies to arbitrary data types, even non-relational data.

OSP’ bespoke fraud management systems can provide user provisioning protocols – including role assignment, user management, and Single Sign-On (SSO) functions. The effective fraud detection software solution is made possible with user activity monitoring, access request management, and account management of multiple digital identities. Furthermore, we deploy automated fraud alerts to monitor patient data and receive emails when new information arises. Our tailored fraud management software allows access to proprietary detection technology, which identifies providers displaying anomalous patient billing trends and patterns through data mining technologies. OSP’s fraud management software is tailor-made to address the vulnerabilities within a particular healthcare organization, in tandem with specific users, providers, and patients in question.

Remain compliant with state policies for healthcare payments to reduce investigation costs and avoid overpayments. Through electronic healthcare fraud detection technologies, we use automated systems that are free of errors, commonly made by human entries. This is because the technology used is consistent in its data entry features and in its analysis of the very same data to ensure holistic compliance. This feature is a must-have and eliminates the requirement for manual intervention of data reentries. The healthcare fraud detection system is geared to generate the data based on initial entries automatically. Thus, the data is organically created and generated and programmed efficiently. The software can be created with the provision of regular updates to keep up with evolving compliance requirements.

OSP’ healthcare fraud detection solutions can be made to find the concealed relationship among multiple payment data parameters, which may not be otherwise apparent. Further, our systems minimize the complexity of visual variance analysis by reducing the multi-dimensional data sets to 2 -3 dimensions. We build healthcare fraud detection solutions to create satisfaction among all healthcare industry entities through a diminished financial burden. Through our customized approach, we adhere to the organization’s specific requirements and build software that is easy to use, rich in features, and user-friendly in its approach through multiple functionality levels. Our software can be well integrated into the EHR system of the healthcare agency or practice.

OSP’s fraud detection software solutions can streamline the process through the entire lifecycle of claims submission. Whether it is a convenience of electronic data entry or validation through the use of technology or even the flexibility of errors being flagged before submission – the benefits are endless of a carefully crafted system that is evident in increasing revenue. Through intelligent technologies within the fraud detection software solutions, we offer the Optical Character Recognition (OCR), which has a high potential in diminishing the possibility of serious errors in coding and claims filing. This is done through the efficient scanning of documents and electronic programming and isolation.

Our solutions are created with the capacity to highlight claims that are likely to be rejected or refused. This will enable faster problem-solving and efficiency, thereby increased. Based on past inputs, our fraud detection software can predict claims that are potentially those which could be denied. Prioritization becomes much easier through this feature, with attention demanded towards areas of immediate attention, such as pending matters. Accessibility is further increased through electronic documentation and records and real-time access to current and past records, along with areas that need to be checked. It also reduces the need for manual processing. Finally, professional claims can be adjudicated in real-time through interactive, transactional experiences.

Benefits 

This is the biggest advantage of using a fraud management system for healthcare payers. Experts estimate that insurance fraud costs billions of dollars annually in losses for the healthcare industry. In light of this, OSP can leverage its decade-long experience in healthcare technology to build custom solutions for payers and improve the efficiency and productivity of claims analytics. This prevents fraudulent claims from being approved and saves precious revenue.  

An average insurance payer may process hundreds of claims daily from numerous payers. In the absence of fraud management systems, verifying each claim is inefficient and slow, and error-prone. As a result, it would take longer to assess and approve or disapprove claims that deviate from normalcy. But using software for healthcare fraud detection accelerates the entire process, getting treatments approved and coverage reimbursed faster.

OSP can build a fraud management solution customized to payer needs that can detect any patterns of deviation from established baselines of regular claims. This not only speeds up the process of identifying suspicious claims but also highlights the methods used by fraudsters to try and pass off inauthentic claims as genuine ones. This type of awareness improves fraud detection's efficiency and productivity and enables payers to respond better to such claims.

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