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APU Data Mining Recovers LTC Overpayments
- 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