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.
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.
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.
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.
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.