We can help make that happen. As a trusted global innovator, NTT DATA assists health plans in harnessing next-generation intelligence and advanced analytics through our Medical Cost Manager (MCM). We combine advanced data management with Fast Healthcare Interoperability Resources (FHIR) for real-time data collection, bringing a unified, holistic view of high data value points from claims and membership information, detecting and preventing overpayment and improving cost avoidance.
Claims Editing Platform
Evaluate claims for coding accuracy and integrate with claims workflow processing in real time, without human intervention.
Coding/Clinical Error Identification
Validate claims data using the platform and clinical analyst to identify inconsistent or incorrectly coded claims.
Consulting & Integration
Provide subject matter expertise support to streamline operations, adopt new technologies and grow your business.
Coordination of Benefits
Streamline recovery for commercial and government plans by using a 360-degree member review and innovative combination of unique algorithms and information from non-conventional data sources.
Review paid claims files and apply data mining/grouping logic/algorithms to identify potential overpayments and provide insights into disbursement leakages.
Identify and coordinate primary payment of claims to prevent or reduce payment/overpayment.