When health plans identify aberrant billing patterns from a provider, it’s only the first step of an often-difficult process to determine whether fraud, waste, and abuse have actually occurred. So how can they ensure their limited resources are being put to their best use?
The provider decision quadrant is a visual decision-making framework that can help a health plan increase both its special investigative unit’s (SIU) operational efficiency and claim payment accuracy without adding staff. This two-dimensional model allows a plan’s SIU to take meaningful provider action by developing actionable leads, prioritizing potential cases for evaluation, and making decisions earlier in the investigation process.
Download our first in a series of “Perspectives” on this topic to learn more.