Quickly discover fraud schemes in your book of business with Provider Scoring™, an advanced lead-generation tool that leverages aggregated industry data and predictive analytics.

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

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.