Payment Integrity for Health Plans

Fight Fraud, Waste, and Abuse at Every Stage of the Process – From Identification to Prevention and Recovery

With over two decades of FWA experience, Truven Health is well positioned to help you exceed these requirements while lowering internal costs and demonstrating a double-digit return on investment.

Our products and services have assisted more than 25 Medicaid agencies and the federal government in identifying millions of dollars in healthcare fraud, waste, and abuse. Experiences in the government sector have provided us a robust framework that is now being used in by commercial plans and managed care organizations to stop abusive billing practices.

Benefits
  • Build robust FWA databases
  • Implement analytic applications
  • Analyze all sources of data
  • Identify fraud, waste, and abuse
  • Target and evaluate payment errors
  • Recover overpayments
  • Prevent future payment errors
  • Predict future costs and areas for payment errors
Our Solutions

Payment Integrity Enterprise - Health Plans
Payment Integrity Enterprise™ delivers maximum value and ROI to health plans. Our expert services - from identification and prevention to investigation and recovery — are designed to help you fight fraud, waste, and abuse.

Advantage Suite - Health Plans
Advantage Suite® integrates information from diverse sources and systems, organizes it to support decision making, and enables easy access to information in a flexible, customized application. Its powerful applications are linked to an integrated warehouse of medical and prescription claims, encounters, eligibility, lab results, authorizations, health risks assessments, and performance measures.

Consulting Services - Health Plans
Grow your business. Mitigate cost trends.Engage consumers and providers. When you partner with Truven Health, we'll put our extensive experience gathering and analyzing healthcare data to work for you. Our on-staff experts can help you leverage the power of data to achieve your specific objectives.

Pharmacy Benefit Strategies
Truven Health Pharmacy Benefit StrategiesSM gives you control over increasing pharmacy costs — without plan design changes or shifting costs.