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Program Integrity Case Management

In order to improve quality of care, cost avoidance, overpayment recoveries, and to better manage financial risk by reducing fraud and abuse, organizations are under increasing pressure to raise staff productivity.  An automated investigative case management system is a key component in the collaborative effort to efficiently manage workflows - to assign cases, review claims, conduct audits and investigations, educate providers, track recoveries, and if necessary, support prosecutions.

The Truven Health Case Management component of our Payment Integrity Enterprise framework provides a secure, robust, highly customizable, and proven solution.  It supports efficient management of the case process, as well as a centralized point of case coordination.

Benefits
  • A centralized, readily accessible web-based repository, with no software to install on desktops
  • Supports cases for recipients, and for single or multiple providers
  • Efficient management of workflow through automated, configurable notifications, assignments, and escalation rules 
  • Built-in time tracking and complete history / audit trails
  • Role-based security 
  • Supports a variety of common attachment formats - spreadsheets, emails, scanned documents, PDFs, audio, photos, and videos 
  • Ability to record and sum recoveries and accounts receivable by case to track compliance
  • Robust search capabilities
  • Integrated, configurable letter templates can be automatically populated from a case file

Our Case Management solution is a web-based, configurable, off-the-shelf (COTS) system currently used by more than 300 organizations across many industries. Learn more today about our Case Management solution.