FICO Releases Insurance Fraud Solution

FICO, a provider of analytics and decision-management technology, has released Insurance Fraud Manager 3.2 (IFM), which scores claims from independent diagnostic testing facilities that provide services such as MRIs and CT scans. 

FICO says that by analyzing medical, pharmacy and dental claims in real time, IFM's predictive models catch fraudulent and erroneous claims before they are paid, saving payers millions and minimizing the pay-and-chase syndrome.

The new release also features enhanced summary reports, which are used as the basis of all fraud investigations, FICO says, as well as further system tuning to improve detection and minimize false positives (suspicious claims that are, in fact, genuine).

With IFM, payers no longer are pressured to pay claims without adequate fraud analysis to meet deadlines or comply with regulatory requirements, FICO says. Additionally, the system is designed to instantly determine what claims to pay automatically, and what claims to review, thereby accelerating the review process and enabling legitimate payments within prescribed time frames.

FICO says its predictive models detect emerging and unknown fraud schemes that are too new, sophisticated or subtle to be caught by traditional rules-based systems, enabling payers to focus investigative priorities to minimize losses and maximize recoveries.   

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