Payor Solutions, Imidex

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Payor Solutions

The Federal Bureau of Investigation estimates healthcare fraud in the range of 3 to 10 percent of all healthcare expenditures [1]. Or, put in US dollar terms, it is somewhere between $75 billion and an eye-popping $250 billion per year. To add to that, this does not include the softer forms of medical abuse: over-utilization of ineffective treatment plans and general malingering. Combine this with an extremely complicated medical system, containing over 17,000 different diagnoses and over 23,000 different procedures, the question is: How does a claims adjuster decide where to focus their interventions to more effectively reduce leakage? And, where does one streamline the processing of medical bills to increase efficiencies and improve the claimant’s experience?

IMIDEX provides Big Data driven medical analytics to more accurately and objectively stratify a claims adjuster’s caseload across a continuum: from usual and customary treatment; to overbilling; to excessive services; to unnecessary services; and to fraud with runners, kickbacks and fraud rings.

We provide solutions to Workers Compensation, Auto insurance, and Health insurance carriers to more objectively and effectively manage claims. We enable a claims organization to quickly identify claims to fast pay, while at the same time identify cases where active intervention is needed by the adjuster, special investigator, independent medical examiner, or other health care provider. This creates efficiencies in the claims handling process by targeting resources towards the most critical areas where leakage occurs.

[1] Federal Bureau of Investigation, Financial Crimes Report to the Public . Fiscal Year 2010-2011.