Payment Integrity

Capture more revenue to reduce inappropriate claims payment

Industries/ Healthcare & Life Sciences/ Health Plans /Payment Integrity

Maximize Revenue With Proven Toolsets

In today’s complex health plan environment, you must analyze huge data loads, coordinate payments to multiple carriers and manage a wide range of health plans across government and commercial clients. This makes payment integrity issues, including fraud, waste, and abuse (FWA), more common. FWA leads to higher costs for you – and higher co-payments and premiums for members. NTT DATA can help. Along with our strategic partners, we deliver solutions that use workflow automation and dashboards to help you proactively detect and investigate non-payable claims.

We can help you capture more revenue and automate payment authorizations with proven toolsets for screening, scoring and coordinating benefits. Our solutions allow you to improve pre-pay screening and scoring for direct savings and scan for program irregularities and billing anomalies. Plus, you can use advanced analytics to improve audit and recovery results and increase referrals using provider risk scorecards. Let’s get started.

Reduce Inappropriate Claims Payments Before They Happen

Our approach to health plan payment integrity solutions helps you proactively detect fraudulent claims with proven toolsets for screening, scoring and coordinating benefits so you can improve payment integrity.

SIMPLIFY

Automate coordination of benefits with other carriers to verify eligibility, coverage, coding

COMPLY

Keep on top of changing federal and state regulatory mandates

RESPOND

Dynamic reporting of multiple performance indicators through automated workflow, dashboards

PROTECT

Implement effective detection, investigation, recovery services

Our Services

Consulting & Integration

Ongoing support and subject matter expertise to analyze existing or needed systems for client-specific business process management solutions.

Coordination of Benefits

Automate benefit coordination with other carriers to verify eligibility, coverage and coding, and identify overpayment, recoveries or claims paid inappropriately.

Reduce Fraud & Waste

Rapidly identify aberrant providers, track member behavior, and use powerful analytics to interrogate claims before you pay.

Subrogation

Orchestrate accurate recovery and payments from a variety of information sources through improved data mining and billing.

Third-Party Recovery

Identify and coordinate the responsible party for primary payment of claims to prevent or reduce payment/overpayment of claims.

Utilization Management

Control the authorization and best use of benefits through licensed care managers, nurses, physicians and other key clinicians.

We can help you capture more revenue and automate payment authorizations with proven toolsets for screening, scoring and coordinating benefits.

EXPLORE OUR INDUSTRIES