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A Verisk Health Company

CLINICALLY VALIDATED FRAUD, ABUSE AND OVERPAYMENT PREVENTION >


Fraud, abuse & overpayment prevention for pharmacy claims >


Just the

right dose of pharmacy

Fraud Prevention

Prevent Fraud | Improve Accuracy | Reduce Costs


PharmaClaim Strengthen your claims payment accuracy, isolate fraudulent providers and reduce your pharmacy claims costs.

“We have a responsibility to protect our client’s benefit dollars and HCI makes that easy for us.” – Renee Haas Employee Benefit Management Corp. (EBMC)

Prevent Fraud | Improve Accuracy | Reduce Costs


THE

THE

Problem

Solution

Fraud Stats 3% – 10% of US pharmacy claim outlay is lost to fraud. By 2013, losses could exceed $30 billion

$30.8 $28.9 $27.2

(In Billions)

$25.6

$7.7 2010

$8.1 2011

$8.7

2012

$9.2

2013

Results > Reduce rising pharmacy expenditures > Improve Rx claims payment accuracy > Increase annual profitability Features > Prepayment analysis on 100% of pharmacy claims > Clinical review on all suspect claims and providers > Code Validator Pro® — Rules-based editing > Fraud Finder Pro® — Provider profiling and scoring > Highly customizable rules and parameters > Real-time claims processing and ad hoc reporting > Clinically-driven appeals support and response > Daily notification of suspect providers and claims identified > Easy to use web-based application > Full-service pharmacy claims cost-containment solution

Fraud Projections for Pharmacy Claims 2010 – 2013 / 3 – 10% loss

10% Loss 3% Loss

Next Steps Contact us for a complimentary Cost Reduction Analysis. Call 1.877.619.5557 or email info@hcinsight.com today.

www.hcinsight.com


HealthCare Insight 10897 S. River Front Parkway Suite 200 South Jordan, UT 84095

Phone 877.619.5557 Email info@hcinsight.com Web www.hcinsight.com


PharmaClaim Insight