“My special investigations unit keeps an eye on fraud and abuse, but what about waste?” The line between fraud and waste may be a fine one, but when you’re convinced that a dubious claim is not fraudulent, does your payer organization have a way of looking into it? And if your organization does pursue waste, are you catching it before payment goes out the door? Or do you have to “pay and chase?” What if your fraud management system were smart enough to detect waste also? The potential for savings is huge in three commonly overlooked areas: too many tests, inefficient claims processing and premature discharge of patients. By using predictive analytics and models, payer organizations can save money by identifying, controlling and stopping unnecessary health care payments
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