Program Integrity Pulse: A Claim Pattern Review case study

Integrating prepay and postpay program interventions is one of the best ways that plans can improve fraud, waste, and abuse (FWA) management and prevention. Watch on demand as we discuss an end-to-end case study involving waste and abuse during our webinar, Program Integrity Pulse: A Claim Pattern Review case study.

Hear from our waste and abuse experts to learn how genetic testing and behavioral health providers were confirmed as billing for services deemed wasteful or abusive. We’ll walk through how these providers were identified for abusive billing patterns with a combination of postpay and prepay analytics, added to prepay review, and denied future improper claims while receiving education to help preempt bad billing behavior going forward.

View the webinar to:

-Learn how a combination of provider and claim-level reviews increases program effectiveness
-Understand best practices in integrating waste and abuse program interventions
-Hear results from an example of prepay review of aberrant claim patterns

00:00 Introduction
01:25 Audience poll
02:32 Agenda and learning objectives
03:55 How to sequence waste and abuse interventions
09:55 Initiating provider review with prepayment intervention
17:55 Maximizing results through simultaneous pre and postpay interventions
21:10 Case study: Waste and abuse in genetic testing
29:25 Case study: Psychotherapy of Licensed Clinical Social Worker (LCSW)
38:05 Conclusion and key takeaways