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thinking inside the box with a provider decision quadrant: monitoring provider network sta...

As we’ve explored in earlier blog posts, the provider decision quadrant uses two dimensions—fraud likelihood score and 1...

thinking inside the box with a provider decision quadrant: identifying FWA and taking acti...

So far in our blog series on the provider decision quadrant, we’ve explained how this tool helps health plans fine-tune ...

thinking inside the box with a provider decision quadrant: identifying FWA and taking acti...

Recently on the Verscend blog, we introduced the concept of a provider decision quadrant to help health plans fine-tune ...

think inside the box on FWA: introducing the provider decision quadrant

Sophisticated data analytics can process billions of claim code line edits at a rapid pace, helping payers identify hund...

can healthcare fraud special investigators keep up the pace?

This week the U.S. Justice Department announced one of the biggest multi-agency healthcare fraud busts in history involv...

when waste becomes fraud: where do you draw the line?

Under HIPAA, healthcare fraud is defined as “knowingly, and willfully executing or attempting to execute a scheme … to d...

busted: the top fraud and abuse busts in Q1 2017

Tens of billions of dollars are wasted each year thanks to fraudulent healthcare billing practices, according to the Nat...

busting myths about clinical claim review

We know that automated claim editing is unable to analyze many claims due to their clinical complexity, the most obvious...

how far can automated claim editing go? three fast facts you should know

There’s no question that automated claim editing is a crucial component of accurate and efficient claims payment. Using ...

the true costs of medical identity theft

$13,500. That is the average cost victims pay to resolve medical identity theft—when they can resolve it.   Medical iden...

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