Payment Integrity

Plans are continuing to identify ways to derive value from their data. This solution provides plans a distinct opportunity to identify opportunities for recovering money from overpayments or mispayments by using the HIG analytical features. IMX provides an actionable report and detailed listing based on algorithms that identify opportunities and possibly streamline the detection process upon which plans spend considerable time – claims adjudication through Claims Excellence programs.

Deliverables

Intelimedix will partner with a client to produce:

An executive summary report detailing the findings and recommendations for recovery
Potential data points including a high-level description/definition of each algorithm, the potential opportunity identified per algorithm, and any mutually-agreed requested points.
A data file with detailed claim line listing that identifies and isolates claims to be investigated along with the algorithm used to identify the claim.
Assistance in determining appropriate measures for application, use, and presentation of the algorithm results to client

Intelimedix’s scope of support focuses on answering client questions about the algorithms and results and does not provide specific consultation on how to recover opportunity dollars.