Apu LTC Presentation

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Apu LTC Presentation

  1. 1. APU … IT’S FOUND MONEY! Mining LTC Claims Data;  Recovering LTC Claims OverpaymentsData Mining & Overpayment Recovery
  2. 2. The Scope of Financial Leakage• Claim payment systems and workflows leak  between 1‐3% of total paid annuallyCustomized Data Mining & Overpayment Recovery
  3. 3. Typical LTC 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
  4. 4. 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
  5. 5. Traditional Countermeasures• Random file reviews• Paper audits• Supervisory controls• Case management• Manual processes that are inefficient and  summary in natureCustomized Data Mining & Overpayment Recovery
  6. 6. 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
  7. 7. 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
  8. 8. 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
  9. 9. 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
  10. 10. The Result APU … IT’S FOUND MONEY!Customized Data Mining & Overpayment Recovery
  11. 11. FOR MORE INFORMATION, PLEASE CONTACT JIM DEL VECCHIO, PRESIDENT & CEO Phone: (866) 434‐8303 Fax: (806) 378‐9822 Email:  jdelvecchio@apuinc.comCustomized Data Mining & Overpayment Recovery

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