HCI Launches Next Generation Anti-Fraud Waste and Abuse Solution

January 1, 2011 / 3 min read

Nucleus application boasts advanced analytics, comprehensive risk scoring, dynamic anti-fraud tools, and a customizable interface to help insurers stop fraud before medical claims are paid

LAS VEGAS, November 16, 2010 — HealthCare Insight (HCI) today unveiled NucleusTM, a next-generation technology platform for fraud, waste, and abuse prevention and detection, at the Annual Training Conference & Anti-Fraud Expo of the National Healthcare Anti-Fraud Association (NHCAA). The Nucleus application features advanced analytics, comprehensive risk scoring, and a customizable interface to help insurers stop fraud before medical claims are paid.

“Healthcare fraud could cost as much as $234 billion this year and is a huge contributor to the rising healthcare costs in America,” said Dr. Barry Johnson, president of HCI. “Nucleus is about giving healthcare payors what they didn’t think was possible. This application combines the best of current antifraud technology, including software as a service (SaaS), prospective detection, customizable dashboards, and predictive analytics. All of the features are packaged in an intuitive, user-friendly, visually enhanced interface that will greatly improve correct payment of medical claims for claims review departments, special investigation units, and medical directors everywhere.”

The multidimensional scoring models of Nucleus enhance fraud detection processes by assigning a relative risk score to each claim and provider. Now HCI’s customers will be able to produce more accurate and reliable fraud, waste, and abuse results while analyzing their medical claims with even greater speed and accuracy. When fraudulent or suspect billing patterns are identified within Nucleus, HCI then sends those claims to its experienced in-house analysts for clinical review. Only then are final recommendations regarding correct payment given to the customer.

“From day one, our goal with Nucleus was simple: to create the most advanced, user-friendly payment integrity application ever,” said Dr. Johnson. “By combining the cutting-edge technology of Nucleus with HCI’s signature clinical review process, we’ve developed the ultimate formula to help insurers’ claims departments, and their SIUs fight fraud, waste, and abuse in ways they never thought possible.”

About HealthCare Insight
HealthCare Insight (HCI), a division of Verisk Health, serves private and public healthcare payors with a new and continually evolving kind of fraud, abuse, and overpayment prevention service. HCI prepayment detection software spots suspect claims and billing patterns in real time through a streamlined software-as-a-service (SaaS) model. It routes flagged claims for validation by experienced clinicians — physicians, registered nurses, dentists, etc. — and seasoned investigators. The result is a high-tech, high-touch process that helps payors make the right payment for the right service to the right provider.

To schedule an interview with Barry Johnson, please call Megan Dubrowski at 201-806-3125 or send her an e-mail at mdubrowski@mww.com.

About Verisk Analytics
Verisk Analytics is a leading provider of information about risk to professionals in insurance, healthcare, mortgage, government, and risk management. Using advanced technologies to collect and analyze billions of records, Verisk Analytics draws on vast industry expertise and unique proprietary data sets to provide predictive analytics and decision-support solutions in fraud prevention, actuarial science, insurance coverages, fire protection, catastrophe and weather risk, data management, and many other fields. In the United States and around the world, Verisk Analytics helps customers protect people, property, and financial assets. For more information, visit www.verisk.com.

Release: Immediate

Contact:
Darin Johnson, VP Marketing
Tel: 801-285-5805
darin@hcinsight.com