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) .

At the onset of the program it is standard to download the health plan’s data history. The history normally includes two or three years of claims data, however the health plan may determine the exact length of time. This data provides a baseline for all of the provider’s business practices. The history is processed and examined by the SIU System on a claim-by-claim basis “flagging” each transaction not in compliance. The analysis and comparative data allows the SIU to isolate providers with outliers compared to like providers in the same geographic area. The transaction flags indicate billing errors and possible recoveries. The history is also used for future claims runs to crosscheck the history to current data.