Company: Ingenix
Product: PowerTrak Alert
Web site: www.ingenix.com

Auto and workers compensation companies can access a new tool to detect suspicious medical bills through PowerTrak Alert from Ingenix, an add-on module for the Ingenix PowerTrak medical bill review solution. PowerTrak Alert helps identify questionable physicians and other healthcare providers before bills are paid to them, helping companies to decrease losses caused by fraud.

According to the Coalition Against Insurance Fraud, fraud costs the insurance industry more than $80 billion a year, and one of its leading types comes in the form of payments to sanctioned, inactive, or phony medical providers. PowerTrak Alert integrates bill adjudication with more than 500 data sources to help property/casualty companies refine their search for suspicious bills.

Jason Beans, CEO of Rising Medical Solutions, an outsource provider for the insurance industry that reviews medical bills and negotiates PPO rates for insurers, explains, Were in the data management business. We manage allowances to providers, provider records, and payment records.

Midwest Insurance Co. uses the bill review services provided by Rising, and Midwest CEO Max Carney asserts the ability to detect fraud has been beneficial to the carrier. Besides being able to save us more money, which is an obvious reason you would change [systems], the service has been more proactive, he says. Midwest saved 23 percent of submitted medical charges last year, according to Carney. [Rising has] been able to point out a few firms that were misusing the medical coverage for soft-tissue injuries, he says.

Rising was in the midst of performing a similar review function on its own before coming across PowerTrak Alert. We decided to take [reviews] up a level and start verifying whether the doctors doing the billing had valid licenses and whether they [had] any sanctions against them, explains Beans. Doctors can be more aggressive in pushing such fraudulent cases when the patients dont have any out-of-pocket expenses, he says.

We wanted the information at our fingertips if there were any sanctions against the doctor or if Medicare or any of the states had reprimanded the doctor for inappropriate billing, notes Beans. Rising had been going directly to the states to verify whether a doctor was licensed, and having the Ingenix tool took the manual workload away from that assignment. By going to the Ingenix product, it allowed us one central repository to accelerate our data gathering. We now can focus our energy somewhere else. We figure we can save our clients a lot of money and help them manage their files more quickly, Beans adds.

Its much more difficult to recover money paid toward a fraudulent bill than to detect and investigate the bill in the first place, says Melissa Tzourakis, Ingenix property/casualty senior vice president. PowerTrak Alert helps P&C companies identify these bills upfront, prior to adjudication, so that the companies can take appropriate action.

Client provider data is checked against sources, and questionable providers are identified based on an aggregate of criteria, including high-risk addresses and names of deceased, sanctioned, or inactive providers, she reports. The provider data is reintegrated into the clients bill review program, and bills from questionable providers automatically are flagged based on this intelligence.

The product also improves the accuracy of provider files by flagging duplicate entries as well as provides value-added provider information, including specialty and subspecialty, medical license information, and billing and servicing addresses, according to Tzourakis.

Company: Tapestry 2004
Product: COSS Development Corp.
Web site: www.cossdev.com

COSS Development Corp., a specialist in illustration and point-of-sale systems for the financial services industry, has released a new version of its business and benefits planning software. Tapestry 2004 is COSS advanced marketing software package and includes a new module dealing with the use of life insurance for charitable giving. The new module provides both a donors perspective and a charitys perspective with regard to the value of life insurance as a vehicle for charitable giving.

With the addition of Charitable Giving, Tapestry contains a total of 21 planning modules dealing with various nonqualified employee benefits, estate liquidity funding, premium funding, mortgage assurance, and the comparative analysis of various financial accumulation and risk transfer vehicles.

Other enhancements included in the new-version release for 2004 are the update of annual blended rate calculations as well as tax-table planning hints for individuals, corporations, and trusts. Tapestry 2004 also consists of updates to accommodate full compliance with regulations governing split-dollar policies.

Tapestry 2004 is being distributed to all current system users as a free version upgrade, or it may be licensed by insurance carriers for distribution to their sales force. It may be integrated to transfer data directly from or to the carriers illustration calculation engine to achieve straight-through processing. Tapestry 2004 can be deployed on both the Web and desktop.

Special Reports /

Insurers put new products to the testimplementation.

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