Payment Integrity
Health plans strive to improve payment integrity by transforming outdated technology and processes, but most point solutions lack transparency or provide one-sided views across business lines. It’s time to shift from the pay-and-chase model of payment integrity to one that enables near real-time accurate payments.
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.
Our Services
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
Ongoing support and subject matter expertise to analyse existing or needed systems for client-specific business process management solutions.
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.
Overpayment Identification
Review paid claims files and apply data mining/grouping logic/algorithms to identify potential overpayments and provide insights into disbursement leakages.
Subrogation
Orchestrate accurate recovery and payments from a variety of information sources through improved data mining and billing.