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white paper: thinking inside the box with a provider decision quadrant

Sophisticated data analytics can process billions of claim code line edits through the course of the day, helping payers...

technology, clinical power, and a unified health plan deliver better results, together

Those who seek to commit healthcare fraud and abuse are continually adapting. Often, they fly just under the radar, with...

busted: top fraud and abuse busts of summer

From California to New York, fraud and abuse took no vacation over late spring and summer this year. The National Health...

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...

are your improper payments hiding in plain sight?

After years of focusing efforts on speeding up automated claim processing, most payers’ claim review systems have uninte...

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