Mckesson integrates fraud, waste and abuse analytic tools into the total payment™ solution

Malvern, pa.--(business wire)--mckesson announces the integration of neural analytics and reporting tools to its mckesson total payment™ solution via the investiclaim™ module. this module allows payers to avoid more wasteful and abusive claims up front and makes fraud recovery efforts more efficient on the back end. the newly integrated investiclaim module now incorporates the total payment claims auditing rules engine and claims operational data store, allowing mckesson to smoothly and effectively combine both clinical rules and pre-pay, data-driven analytics on the same transaction platform to stop more wasteful and abusive claims pre-pay than ever before. in addition to existing advanced claims editing capabilities, the total payment solution now prevents wasteful or abusive spending in two more ways with the investiclaim module. first, it uses powerful data-driven analytics to stop individual suspect claims that pass through rules, allowing a final pre-pay review. second, it adds provider analytics to continuously scan high volumes of post-pay claims to identify aberrant billing patterns and provide the rationale for the aberrancy. clients can use the investiclaim systemic weakness reports to identify wasteful or abusive practices that can be prevented in the future by creating new rules with the flexible total payment rules engine. investiclaim also provides extensive workflow functionality for full collaboration among special investigations, claims operations and auditing departments, as well as an integrated case management tool that tracks all activity relating to a specific case or audit for a clear documentation trail. “the public and private sectors are clearly focused on aggressive measures to prevent waste, fraud and abuse, but they need innovative technology approaches to get there,” says jim evans, vice president, payment management and analytics, mckesson health solutions. “by combining the best of rules-based tools with innovative pre-pay analytics, our total payment solution provides payers with a proactive and automated way to stop more waste, fraud and abuse all along the payment continuum, saving medical and administrative costs on an ongoing basis. and, as the industry approaches the transition to icd-10 claims coding in 2013, using this combination of rules and analytics as a real-time monitoring device will be more valuable than ever for our payer partners.” about mckesson mckesson corporation, currently ranked 15th on the fortune 500, is a healthcare services and information technology company dedicated to making the business of healthcare run better. we partner with payers, hospitals, physician offices, pharmacies, pharmaceutical companies and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting. mckesson helps its customers improve their financial, operational, and clinical performance with solutions that include pharmaceutical and medical-surgical supply management, healthcare information technology, and business and clinical services. for more information, visit http://www.mckesson.com.
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