Benefits

Standard automated claims processing is not sufficient to protect a health plan against fraud and abuse. The more automated a claims processing system becomes, the easier it is for a perpetrator to go undetected and the likelihood that the health plan will pay for these fraudulent claims is almost certain.

Automation of claims processing is important to a health plan’s business, but automation is being exploited. Proper fraud control measures are essential for the financial future of a health plan.

The investigation of fraud and abuse cannot solely rely on automated claims processing technology. AMG-SIU blends this technology with hands-on research and reasoning. Once AMG’s process of fraud investigation is in place, health plans realize the return far outweighs the investment.

Key Features

• Saves health plans money
• Provides comprehensive training to prevent incorrect payments
• Provides a cost effective means of outsourcing
• Allows health plans to avoid increasing staffing costs
• Allows health plans to avoid purchasing expensive equipment
• Allows health plans to avoid costly fraud and abuse training and supervision development
• Prepares necessary OIG SIU reports
• Provides online services through a HIPAA compliant secure website
• Provides an extensive array of online comprehensive reports.