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) .

Through our HIPAA-compliant secure website, health plans manage their liability along with identifying potential fraud, waste and abuse.

Management and Financial Reports

The key to managing a health plan is the ability to review the claims data and determine the fiscal health of the block of business. Through the paid claims data the report module allows the plan to identify:

• Claims Paid Lag Time
• Potential Third Party Liability
• Potential Stop Loss Claims
• Outliers by Provider / Service Code / ICD
• Utilization Reports – Including Line of Coverage
• Case Management

Data Analysis Reports

The data analysis reports are tools used to identify potential fraud, waste and abuse. The SIU system has predefined service and diagnosis groupings allowing users to select search criteria on a global level or on a specific code basis. These reports are available on-line and include:

• Provider Reports
• Member Reports
• Monitoring Reports
• Utilization Reports
• Prescription Drug Reports
• Investigation Reports, including Quarterly OIG Reports
• Recovery Reports
• Additional Reports