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CLAIMS ANALYTICS

Milliman Payment Integrity

Milliman Payment Integrity is an intelligent healthcare auditing solution that enables healthcare organizations to detect and reduce fraud, waste, and abuse, leading to substantial cost savings and improved revenue integrity.

The challenge

Rising healthcare costs and waste

Healthcare organizations face a critical challenge: the soaring cost of care and the billions of dollars lost annually to healthcare waste and fraud. The need for efficient auditing and fraud prevention is more pressing than ever. Identifying and addressing these inefficiencies can help keep healthcare plans affordable, and reduce the overall cost of care.

The solution

Intelligent claims auditing

Milliman Payment Integrity enables clients to audit 100% of medical and pharmacy claims, testing for millions of possible issues in more than 70 categories, using advanced Milliman MedInsight analytics and tools. The intuitive interface gives medical and pharmacy fraud investigators easy access to drill-down analytics, dashboards, and reports, empowering your team to address potential issues quickly.

BENEFITS

Milliman Payment Integrity benefits

Automate claim audits

Streamline the auditing process with comprehensive scanning of all claims, identifying issues in more than 70 categories for increased accuracy and efficiency.

Identify billing errors

Target and scrutinize claims likely to contain errors—including billing anomalies, duplications, and overpayments— from a detailed list generated by automated audits.

Enhance decision making

Use MedInsight’s advanced analytics for deeper insights, enabling better strategic decisions in managing fraud prevention, optimizing costs, and maximizing revenue integrity.

FEATURES

Milliman Payment Integrity features

Severity scoring

Focus on significant issues with a system that filters out less critical concerns.

Payment recovery calculator

Estimate potential recovery and enhance financial decision-making.

MedInsight reporting

Use advanced reporting tools for actionable insights and seamless integration.

Insight

Related Insight

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Article

How effective claims auditing can save healthcare dollars lost to fraud, waste, and abuse

Effective claims auditing can help detect instances of FWA, thereby saving payers money, lowering overall healthcare costs, and potentially improving patient outcomes.

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