thinking inside the box: monitoring provider network stability

Verscend recently introduced a series of Perspectives on the concept of a provider decision quadrant to help health plans fine-tune the prioritization process when it comes to addressing potential fraud, waste, and abuse (FWA) in their provider networks. Our first Perspective introduced how the quadrant replaces the more traditional approach of simply examining the fraud likelihood score with one that also looks at paid-claim exposure. In our second Perspective, we performed a closer examination of providers who reside in the low-risk quadrants, and in our third Perspective, we zeroed in on the high-risk quadrants.

Now, in our fourth and final Perspective on this topic, we look at migration patterns between the quadrants that health plans should monitor closely. We examine which quadrants experience the most change and what payers should do when they see a provider move from one quadrant to another.

Download our fourth Perspective to learn more.

accountable-care-organization health-insurer medicare-advantage-plan medicaid-agency no payment-accuracy none no fraud-detection none no no no no no reports no no no

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