preventionadvanced analytics

"Healthcare fraud could cost as much as $234 billion this yearand is a huge contributor to the rising healthcare costs inAmerica," says Dr. Barry Johnson, president of HCI. "Nucleus isabout giving healthcare payors what they didn't think was possible.This application combines the best of current antifraud technology,including software as a service (SaaS), prospective detection,customizable dashboards, and predictive analytics. All of thefeatures are packaged in an intuitive, user-friendly, visuallyenhanced interface that will greatly improve correct payment ofmedical claims for claims review departments, special investigationunits, and medical directors everywhere."

The multidimensional scoring models of Nucleus enhance frauddetection processes by assigning a relative risk score to eachclaim and provider. Now HCI's customers will be able to producemore accurate and reliable fraud, waste, and abuse results whileanalyzing their medical claims with even greater speed andaccuracy. When fraudulent or suspect billing patterns areidentified within Nucleus, HCI then sends those claims to itsexperienced in-house analysts for clinical review. Only then arefinal recommendations regarding correct payment given to thecustomer.