There’s proof in performance reporting.

You know data analysis and reporting reveal performance issues, but you can use data to continuously improve coverage determinations, too.

Our experienced data analysts use SAS® — a leading statistical analysis software suite — and data warehousing to analyze paid claims data, prioritize your risk, and identify problematic code and provider trends. We then generate reports that isolate provider trending and comparative billing, analyze geographic hot spots, and identify unusual billing combinations that can signal fraud and abuse.

Our goal is the quick identification of provider trends that can be rectified by system edits at the time they are submitted, before payment is made. Provider trends can also indicate reviews of local coverage determinations (LCDs) or signal a provider’s failure to correct aberrant billing practices.