Improve your loss ratio and reduce loss adjustment expenses
Medical fraud, waste, and abuse cost insurers at least $80 billion each year. Medical expenses associated with bodily injury claims are one of the leading drivers of allocated loss adjustment expenses (ALAE). Does your SIU team have the information they need to fight medical billing fraud?
Unlock ROI and long-term benefits
Provider Scoring provides a range of ROI metrics to support your success in the first year, champion your achievements, and ensure continued long-term benefits.
Hit the ground running with greater insights
SIU investigators get qualified leads backed by specific issues so they can devise investigative plans, launch factual examinations, and develop questions for interviews, examinations under oath, and depositions.
Detect and deliver better analytical leads
Provider Scoring analyzes massive amounts of providers to spotlight outlier trends and patterns of practice, including high exposures and emerging schemes, so SIU analysts can identify which providers to focus on in their book of business.
Get significant ROI from actionable leads
With leads vetted simply and quickly, teams will know which providers to investigate and why, and SIU managers can articulate ROI with several tangible success metrics.
Save time, reduce expense, realize ROI
Achieve return on investment in the first year and beyond with several different metrics:
Reduce analytical and investigative cycle times
Increase loss avoidance
Improve quality of referrals
Robust data powers deep analysis
Medical Provider Scoring doesn’t stop with your data. It analyzes data from the Aggregated Medical Database—the largest P&C billing data repository.
- 2M+ providers
- 5M+ patients
- $47B+ billing financial exposure
Robust data powers deep analysis
Features and capabilities
Increased FWA detection
Provider Scoring uses more than 100 advanced analytic models, casting a wider net to find more fraud, waste, and abuse (FWA).
Core referral metrics
Get insights on which providers may be submitting questionable bills and specific reasons the providers triggered potential FWA issues.
Financial impacts of FWA on your business
See projected patient counts and estimated dollar amounts billed by highlighted providers for each triggered reason, as well as benchmarking of the provider’s total billings among their specialty peers.
Related resources
Learn more about how to uncover medical provider fraud.
Resource center
Stay informed on the latest innovations
Discover the latest features and enhancements to our Claims solutions including ClaimSearch®, Digital Media Forensics, Claim Scoring and more to seamlessly adapt to updates and maximize efficiency.
Article
Leveraging Data Effectively to Uncover Questionable Medical Provider Billing
Learn how to methodically analyze provider data to uncover fraud—one focused, strategic step at a time.
Case study
Major P&C insurer uncovers medical provider fraud with innovative analytic solution.pdf
Learn how a top 10 insurer used medical provider scoring to uncover over $170K in questionable bills from a physical therapy practice.
Brochure
The analytics and insights you need in a workflow built for speed
Carriers primarily face two challenges in detecting suspicious billing activity: finding which providers are submitting questionable bills and determining what specifically is questionable in the bills.
Do more with the Verisk ecosystem
Provider Scoring is part of a full suite of claims solutions that provide compliance, claims development, and deeper fraud analysis and tools.
The world’s largest P&C claims database
Fast-track claims while improving fraud detection with access to data from more than 1.8 billion claims.
Missing details to complete claims
Get hundreds of supplemental data reports to enhance claim analysis and investigations.
Claim scoring through predictive analytics
These models deliver enhanced claim scores and reason codes to detect potential fraud and support investigations.
Fraudulent images in claims identified
This automated process applies a series of algorithms to every customer-submitted loss photo to expose anomalies.
Advanced link analysis to fight organized insurance fraud
Discover the hidden relationships and connections among claimants, providers, and businesses.
Contact us to learn more
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