This document discusses how APU provides data mining and overpayment recovery services for long term care (LTC) insurance claims. It notes that claim payment systems typically leak 1-3% of total payments annually through errors. APU customizes data mining analytics to analyze all claims data and identify overpayments, recovers identified overpayments, and returns the recovered funds to clients, providing a risk-free service paid only on contingency from recovered amounts. The benefits for clients include recovering leaked funds, cleaner data, and improved payment processing without significant effort or startup costs.

1. APU … IT’S FOUND MONEY!
Mining LTC Claims Data;
Recovering LTC Claims Overpayments
Data Mining & Overpayment Recovery

2. The Scope of Financial Leakage
• Claim payment systems and workflows leak
between 1‐3% of total paid annually
Customized Data Mining & Overpayment Recovery

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 process
Customized Data Mining & Overpayment Recovery

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 sources
Customized Data Mining & Overpayment Recovery

5. Traditional Countermeasures
• Random file reviews
• Paper audits
• Supervisory controls
• Case management
• Manual processes that are inefficient and
summary in nature
Customized Data Mining & Overpayment Recovery

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 prospectively
Customized Data Mining & Overpayment Recovery

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 client
Customized Data Mining & Overpayment Recovery

8. The Benefits
• Recover 1‐3% of total dollars paid
• Cleaner data
• Fundamental system errors identified
• Improved payment processing
• Outsourced solution frees up internal
resources
Customized Data Mining & Overpayment Recovery

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 minimum
Customized Data Mining & Overpayment Recovery

10. The Result
APU … IT’S FOUND MONEY!
Customized Data Mining & Overpayment Recovery

11. FOR MORE INFORMATION,
PLEASE CONTACT
JIM DEL VECCHIO,
PRESIDENT & CEO
Phone: (866) 434‐8303
Fax: (806) 378‐9822
Email: jdelvecchio@apuinc.com
Customized Data Mining & Overpayment Recovery