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) .

AMG-SIU provides a recovery tracking program to its clients and is available to assist a health plan in obtaining reimbursement for incorrectly paid claims or fraudulent and abusive conduct.

Most claim errors, fraud, waste and abuse issues are determined prospectively at the time of claim payment and are deducted from the claim amount paid to the provider. However, there are some areas that are not detected during the prospective edits. These areas include the retrospective review of claims paid (such as claim history, prospective claim not adjusted prior to payment, or an expedited claim payment outside the normal claims procedures) and provider and member claims identified through data analysis.