Public Sector

Public Sector Payor solutions for Medicaid States and MCOs and Medicare Advantage and Special Needs Plans

Health Care Fraud Prevention Services for Medicare Advantage special needs plans and medicaid states

It's Time to Control Health Care Costs
HCI provides public sector claims payors (Medicaid, Medicare Advantage, SCHIP, etc.) with a comprehensive suite of clinically validated fraud and abuse surveillance services designed to maximize claims administration accuracy and minimize payment waste. Each of HCI’s customizable software as a service (SaaS) solutions rely on a unique prepayment process that combines proprietary software systems with detailed review by experienced clinicians (doctors, nurses, dentists, etc.) and investigators on all suspect claims and billing patterns. HCI’s differentiated process enables payors to target fraud with greater efficiency by significantly increasing the quality of results returned while decreasing the total number of false positives.

Health Care Fraud Prevention Services Case Study

“HealthCare Insight® has prevented the payment of over $4 million in inappropriate charges and fraudulent health care claims for our members." - Michael De Chellis
OE Trust Funds Inc.

DentalClaim Insight™
PhysicianClaim Insight™

FacilityClaim Insight™
RxClaim Insight™