Pre-Payment and Post-Payment Analytics
HealthMind eAudit is performed on high volume data to identify patterns and anomalies that can impact payment. Our proprietary technology blends rule–based logic, with clinically and medically developed data intelligence not available through other companies today. ReThink™ analyzes claims to accurately and efficiently identify provider submissions not in compliance with your company’s policies, contracts and billing standards for physician, inpatient and outpatient services.
eAudit is an automated, iterative process of selecting, exploring and modeling large amounts of data to identify meaningful, logical patterns and relationships and can be applied to a retrospective analyses across multiple years of paid claims data. The service pinpoints errors in billing standards or claims processing that have gone previously undetected. The ReThink™ platform applies highly sophisticated algorithms to evaluate issues related to eligibility, duplicates, National Correct Coding Initiative (NCCI), Medically Unlikely Events (MUE) and others. The technology operates in a pre- and post-pay continuous loop with dynamic discovery of patterns and provider abuse within a seamless environment and a fully integrated workflow.
how it works:
- Operates in a fully integrated pre-and post-pay environment
- Blends rule-based logic with pattern recognition
- Easily customized to each client’s policies
- Multi-year analyses capabilities
- Provides a compelling and easy to understand ROI