monitor, detect, analyze and prevent fraud, waste and abuse.

Dig beyond the surface to uncover the answers.

The Answers Suite is an integrated arsenal of medical record analysis and fraud detection applications. Armed with quality control mechanisms, intuitive analytics, and interactive reports, Answers gives you the tools to combat fraud, waste, and abuse.

Investigators and analysts will agree that Answers can serve as the first line of defense to prevent, deter, identify and resolve high risk situations.

DETECTION AND MONITORING

Supporting Utilization Review

Various team members can simultaneously examine specific datasets related to diagnosis, payment patterns, medical providers, patients, prescriptions, and demographic and peer-to-peer comparisons.

Encourage productivity

Users can review an unlimited number of medical records and claims with greater speed and accuracy. For added efficiency and convenience, Answers comes with the complete set of industry standard procedures and diagnoses codes (CPT and ICD-9 and ICD-10).

Retrieve several years of active files

Answers is customized to work in conjunction with customers’ database and processing systems. Revolutionary storage capabilities uniquely enable customers to electronically retain active medical records and historical data for 7+ years.

ANALYSIS AND REPORTING

Reinforce effective team work.

The Answers report wizard makes it easier for users to compile, save and share reports within fraud units, and across regions. Reports can also be printed or exported to spreadsheets, pdf, and word (doc) formats.

Get a multi-dimensional view of every claim

The system’s interactive reporting system has data mining and drilldown functionality. Users will be amazed at their ability to easily single out one claim out of thousands. Investigators and analysts will find that documentation generated with Answers, will help them focus on problem areas.

Prepare interactive and in-depth reports

Users can quickly build, graph, and share reports with an ad-hoc report type or based on pre-defined parameters. Answers can identify profiles of utilization and costs by provider, facility, diagnoses, procedures, and location, among others.

DATA MINING, MODELING AND ALERTS

Control access to sensitive data

Role based security and password encryption empowers managers and system administrators to control access to program functions and data. Answers is also password encrypted.

Identify emerging risks

Rule and behavior based algorithms with set risk thresholds ensures various data analyses including comparative and trend analyses, *LEIE match assessments, and predictive models routinely run. Discrete alert system triggers red flags as potential risks and significant outliers arise.

Review shifts and data spikes at a glance

The Answers smart dashboard uses current data to display graphic depictions of reports preselected by the user. A toggle option enables users to quickly switch between graph and table view.

*List of Excluded Individuals/Entities