THE SCOPE OF FINANCIAL LEAKAGE: Claim payment systems and workflows leak between 1-3% of total paid annuallyCustomized Data Mining & Overpayment Recovery
Typical Payment Approach• Prospective• Algorithmic in nature• Ad hoc, claim-by-claim basis• Uses underdeveloped claims systems• Limited plan/payment logic• Human-based processCustomized Data Mining & Overpayment Recovery
Sources of Leakage• Personnel changes• Data entry errors• Multiple billings/inconsistent cycles• Peripheral data errors (vendor, policy, enrollment, check writing)• Manual overrides• Manual checks• Inconsistent connections between peripheral data sourcesCustomized Data Mining & Overpayment Recovery
Traditional Countermeasures• Random file reviews• Paper audits• Supervisory controls• Case management• Manual processes that are inefficient and summary in natureCustomized Data Mining & Overpayment Recovery
The APU Solution: MINE DATA• Collaborate with client to identify errors• Construct client specific analytics that review ALL claims• Don’t AUDIT claims data; MINE claims data• Articulate claim, policy, provider, and payment data in a “mine-able” format• Analyze at the transaction level• Think retrospectively, not prospectivelyCustomized Data Mining & Overpayment Recovery
The APU Process: RECOVER OVERPAYMENTS• Use existing client data extracts• Automate production and delivery of inquiry letters• Follow up and resolve overpayment requests• Handle all inquiries• Receive and account for reimbursements• Provide full accounting and a CHECK to clientCustomized Data Mining & Overpayment Recovery
The Benefits• Recover 1-3% of total dollars paid• Cleaner data• Fundamental system errors identified• Improved payment processing• Outsourced solution frees up internal resourcesCustomized Data Mining & Overpayment Recovery
The APU Value Proposition• No start up costs• Risk free: We work on a contingency basis; we only get paid when we recover your money• Little effort: Client involvement is kept to a bare minimumCustomized Data Mining & Overpayment Recovery
The Result “APU … IT’S FOUND MONEY!” - Brad J., Dental Insurance ExecutiveCustomized Data Mining & Overpayment Recovery
FOR MORE INFORMATION, PLEASE CONTACT JIM DEL VECCHIO, PRESIDENT & CEO Phone: (866) 434-8303 Fax: (806) 378-9822 Email: firstname.lastname@example.orgCustomized Data Mining & Overpayment Recovery
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