"Healthcare fraud could cost as much as $234 billion this year and is a huge contributor to the rising healthcare costs in America," says Dr. Barry Johnson, president of HCI. "Nucleus is about 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 the features are packaged in an intuitive, user-friendly, visually enhanced interface that will greatly improve correct payment of medical claims for claims review departments, special investigation units, and medical directors everywhere."

The multidimensional scoring models of Nucleus enhance fraud detection processes by assigning a relative risk score to each claim and provider. Now HCI's customers will be able to produce more accurate and reliable fraud, waste, and abuse results while analyzing their medical claims with even greater speed and accuracy. When fraudulent or suspect billing patterns are identified within Nucleus, HCI then sends those claims to its experienced in-house analysts for clinical review. Only then are final recommendations regarding correct payment given to the customer.

"From day one, our goal with Nucleus was simple: to create the most advanced, user-friendly payment integrity application ever," says Dr. Johnson. "By combining the technology of Nucleus with HCI's signature clinical review process, we've developed the ultimate formula to help insurers' claims departments, and their SIUs fight fraud, waste, and abuse in ways they never thought possible."

Special Reports /

HCI Launches Anti-Fraud, Waste, and Abuse Medical Claims Solution

Related Stories

Recommended For You