Vendors Team To Scan Claims for Fraud, Abuse

Revenue cycle management vendor Emdeon Business Services will embed software in its transactions processing network to analyze claims being edited and submitted to insurers for patterns of fraud and abuse.

The Nashville-based company is using the Insurance Fraud Manager application of Minneapolis-based FICO, formerly Fair Isaac Corp. Among its other services, Emdeon operates the nation's largest health care claims clearinghouse.

The vendor alliance enables Emdeon to bring a value-added service to insurers by scanning claims for patterns of fraud and abuse prior to adjudication or at other points during the claims process.

Emdeon and FICO conducted a pilot of scanning de-identified data from two states, and identified millions of dollars in potential savings from claims with indications of fraud, waste or abuse, according to the companies.

This article was reprinted with permission from Health Data Mangement.