AMG-SIU provides an array of health care claims editing services and fraud and abuse services. These services are offered separately or in combination according to your specific needs (See Program Options). While a few services must be combined, the remaining services are optional and may be provided by your existing staff (or ours) .

(Data Matching, Trending and Statistical Analysis)

Data analysis identifies abnormal service patterns, potential areas of over-utilization or under-utilization, changes in provider behavior, and possible billing schemes. This process identifies practices that pose the greatest financial risk to the health plan.

The SIU system, through analytical methodologies, uses multiple reporting capabilities to identify potential errors, fraud, waste and abuse. Data analysis is an integrated component of the SIU system. Data analysis varies based on the specific incident being investigated.

The data analysis:

• Establishes a baseline to enable the SIU to recognize unusual trends, changes in utilization, and/or schemes to inappropriately maximize reimbursement.
• Identifies specific provider and common billing patterns.
• Identifies high volume or high cost services.
• Identifies provider and patient utilization patterns.
• Identifies provider referral patterns.