Datamethod introduces Claim Risk Index: identifying financial errors on healthcare claims

Aug. 20, 2012 - PRLog -- Datamethod introduces Claim Risk Index: Using the power of predictive analytics to identify financial errors on healthcare claims

Lexington, Massachusetts – August 21st, 2012 – Datamethod today announced their Claim Risk Index tool. Claim Risk Index or (CRI Score) is the first industry use of predictive analytics to identify financial payment error risks with healthcare claims.  The new offering is now integrated into Datamethod’s ClaimAuditor application and enables Audit Managers to directly sample high risk claims in addition to their existing pre-defined random samples.

Datamethod’s CRI Score is generated based on two sets of variables: (1)  prior claim audit error history  (2) over two dozen common claim and claim line attributes (examples of which include, denial reasons, hold codes, pend codes, paper versus EDI, COB,…) to create a scoring model to identify payment risk. Every claim is processed through the Claim Risk Index rules engine and assigned a risk score for financial error and risk descriptions. Audit managers are then provided the ability to both create risk based samples and view the CRI Score with descriptions when auditing any of their claims.

“One of Datamethod’s strategic goals is to lead the claim audit industry forward using tools and insight” says Datamethod’s COO Ryan Duke, “The Datamethod team spend years working to design and refine the Claim Risk Index to accurately provide a risk assessment of all claims. Leveraging a robust dataset of prior error history we can provide Audit Managers powerful insight they previously could have only dreamed of”.

All organizations understand the value of identifying financial payment errors, but many struggle to extract new insight from existing claim data. Datamethod brings powerful insight to the market with their insight initiative. Future predictive analytic models that are currently in development include provider and employer group indexes, high dollar claim identification on open claims prior to posting, and the ability to use risk indices to identify similar claims to an error for recovery.

“Our current clients have shown an overwhelmingly positive response to the introduction of CRI to their ClaimAuditor applications.” says Ryan Duke, “It’s a simple, easy to understand measure that helps with all audits. Auditors are using the CRI descriptions to help guide what they review when auditing a claim. This gives them another powerful tool in the ClaimAuditor application.”


Contact:
Ray Kobs
rkobs@datamethod.com
http://www.Datamethod.com
Phone: (781) 402-0006


About Datamethod
Datamethod is an industry leader in providing complete software solutions for claims sampling, audit management, recovery, reporting, and compliance. Our integrated platform removes the common headaches with single purpose or home grown applications and the need for spreadsheet workarounds.

National payers using our platform have achieved significant measurable improvement in auditor productivity, overpay recovery, reporting insight, and perhaps most important, audit integrity and compliance. Our platform automates and logs each audit step, from sample setup, to claim review, to back end audit result reporting.

Learn more at www.datamethod.com