Castlestone's VisitEye system uses member ID cards with magnetic stripes to capture health care transactions at the point of sale. When a card is swiped, data is sent through credit card networks to Castlestone for real-time verification against claims and rules to approve, deny, or refer transactions. Implementation takes 60-90 days and uses existing credit card terminals and networks, with costs including setup, hosting, and per-member transaction fees. Typical results show setup completion in 60-75 days and ROI ranging from 125-200% for fraud prevention.

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Preventing Fraudulent
Transactions in Health Care
How Castlestone’s VisitEye Works
May, 2014

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Key Elements
• Setting up Castlestone’s VisitEye in 60-90 days:
• Visit Eye Integration
• Visit Eye Transactions
• Castlestone’s VisitEye in Operation
• Cost and Implementation Considerations
• Typical results

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Setup: Integration - purposely limited using secure FTP file transfers
and standard queries/updates to plan sponsor
Providers sFTP
Member Status
Batch Updates
Standard Queries
Download of Transactions sFTP
Plan sponsor
Card Status
• Create
• Replace
• Cancel
• Update
VisitEye

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Set-up: VisitEye Transactions – ID cards, POS transactions,
Customized analysis
Plan sponsor ID Cards
with mag stripe
Rules for
POS keystrokes
Customized Analyses/Reporting
& Card-to-claim matching
Created and distributed
cards
Management of the card
base:
• Issuance,
• Cancellation,
• Replacement
Combinations of POS keyed
transactions, card type, POS
location create plan sponsor-
specific actions for service
provider and plan sponsor. E.g.:
• Swipe terminal eligibility alerts and
reports
• Chart review for power mobility
equipment
• Swipe and claim at doctor
compared to lab tests,
transportation bills, etc.
VisitEye Portal
• Swipe transactions details
• Pre-configured reports,
e.g.:
• Card # lookup
• Approved transactions
• Rejected transactions
• Providers/Suppliers
• Ad-hoc reporting
capabilities

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Set-up: About Card Issuance
• Compliant to health plan standards for card/track
encoding, and allows for standard printing
• Existing manufacturer contracts can be used
• Graphics and text remain the same; the plan
sponsor initiates any change
• Castlestone assigns 16-digit card network number
• No PHI and no financial value
• Plan sponsor or administrator updates card status
(add/change/replace/cancel)
– Can change card status from portal
– Castlestone implements the change
• Plan sponsor can also opt for delivery verification
and other anti-fraud measures

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The patient swipes personal insurance I.D. card, with a Castlestone mag
stripe, in the same terminal used for credit card transactions
At the:
• Merchant
• Provider
• Physician
• At home
1. Patient
swipes card

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That card is verified as is the terminal owner, location, merchant
code, transaction and time stamp
2. Data on Card ID, Terminal Owner, Terminal Location
Merchant Code, Transaction Code, Time Stamp
At the:
• Merchant
• Provider
• Physician
• At home
1. Patient
swipes card
(via credit card network infrastructure)
Castlestone runs rules against each
swipe, in real time, e.g.:
• Do we know that swipe terminal in
our database of providers?
• Is that swipe terminal a medical
merchant code?
• Has that card been reported lost or
stolen? Are there restrictions?
• Has that card been swiped today at
another location?

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These data are matched versus existing claim and prescription
records
2. Data on Card ID, Terminal Owner, Terminal Location
Merchant Code, Transaction Code, Time Stamp
3. Claim Matching
• Recipient name
• HealthPlan ID
• Provider IID
• Existing Rx for Class II drug?, etc.
At the:
• Merchant
• Provider
• Physician
• At home
1. Patient
swipes card
Health Insurer’s Analytics
(Can include FPS-like analytics)
Card Swipe Details
Card Number: 5424176022824317
Name: Mitchell Clark
HealthPlan ID# 6789b
Provider ID# 0077464
Swipe Terminal ID9443C3002846
(registered to Dr. Byron Black)
Date of Transaction:1/15/14
Time of Transaction 10:06:23
Claim Details
Recipient Name Mitchell Clark
Name: Mitchell Clark
HealthPlan ID# 6789b
Provider ID# 0077464
Provider Name:
Byron Black, MD
Date of Service:1/15/14

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Card Swipe Details- Provider Office or
Patient Home
Card Number: 5424176022824317
Name: Mitchell Clark
Plan ID# xxx-xx-6789
Prescriber ID# 0077464
Prescriber Name:
Richard Howard, MD
Rx Date: 8/1/13
Order Code: 11551
Claim Details
Recipient Name Mitchell Clark
Name: Mitchell Clark
HealthPlan ID# 6789b
Provider ID# 0077464
Provider Name:
Byron Black, MD
Date of Service:1/15/14
Outpatient matching adds the supplier match to the claim and the
provider/office match
Card Swipe Details- Supplier
Card Number: 5424176022824317
Name: Mitchell Clark
Plan ID# xxx-xx-6789
Supplier ID# 0088444
Supplier Name:
Flexmax Medical Supply, Trenton NJ
Date: 8/1/13
Order Code: 11551
Matching
• Verifies outpatient visit
• Verifies location of visit
• Verifies provider and proper
location match
• Attests that physician order came
from physician office
• GPS location verification of home
care service
• Blocks order after fill

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The transactions are usually immediately approved, denied or
referred for further information
2. Data on Card ID, Terminal Owner, Terminal Location
Merchant Code, Transaction Code, Time Stamp
3. Claim Matching
• Verify terminal code
• Verify medical merchant code
• Lost or stolen card?
• Previous time and location of swipe
• Existing Rx for Class II drug?, etc.
4. Approve, Deny or Refer
At the:
• Merchant
• Provider
• Physician
• At home
1. Patient
swipes card
Health Insurer’s Analytics
(Can include FPS-like analytics)
(via credit card network infrastructure)

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When referred, the provider and/or the patient is contacted by the
insurance company before the transaction is approved
2. Data on Card ID, Terminal Owner, Terminal Location
Merchant Code, Transaction Code, Time Stamp
3. Claim Matching
• Verify terminal code
• Verify medical merchant code
• Lost or stolen card?
• Previous time and location of swipe
• Existing Rx for Class II drug?, etc.
4. Approve, Deny or Refer
5. On referral, verify before taking
action
At the:
• Merchant
• Provider
• Physician
• At home
1. Patient
swipes card
Health Insurer’s Analytics
(Can include FPS-like analytics)

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Cost and Implementation Considerations
• Card Creation
– Castlestone creates/activates/deactivates and manages cards based on guidelines. Plan
Sponsor existing card manufacturing contracts can be used if they are compatible
• Hardware cost for plan & providers
– NONE. Uses existing credit card terminals
• Network costs for plan & providers
– NONE. Uses the existing credit card networks from provider offices for transactions
• Systems & programming costs
– S&P is very simple data exchange of new/change/delete clients or full real time integration
• Cost Structure
– Design and programming & card cost
– Hosting (data base & monthly hosting and management)
– Monthly per-member transaction fees

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Typical Results
• Set up completely implemented in 60-75 days
• All technical milestones (transaction capture, claim matching, file and
interface implementation) exceed goals for speed and performance
• ROI for fraud prevention ranges from 125%-200% and can significantly
exceed this

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Contact Us
Doug Brockway
Advance Consulting
(617) 834-0067
dbrockway@advancecons.com
www.advancecons.com
CIO Advisory | Program Management | Business Development