Medicaid Program Integrity

The need for accurate and reliable operational benchmarks has never been greater. Healthcare executives must continue to manage operations more effectively, ensuring quality care while keeping costs under control.

Get to know the Payment Integrity Enterprise

Get to know the Payment Integrity Enterprise

 

Our Product and Services Include:

Provider Surveillance

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.

Prepay Review and Prevention

Proactively target high risk claims and providers for intervention up stream in the payment process using; innovative predictive models, efficient workflow management, and powerful forensic review tools that arm your team with information to take action.

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.

J-SURS™ Fraud and Abuse Detection System

Healthcare payers must be able to detect and deter those few providers and beneficiaries who attempt to abuse or defraud their systems. While the individuals are few in number, the losses are substantial, and they affect both the bottom line and ultimately the quality of care. J-SURS from Truven Health gives you a powerful and user-friendly stand-alone solution for fighting healthcare fraud and abuse. J-SURS not only integrates easily into your existing environment; it also provides easy, effective review and analysis of claims data to all users – from data specialists to medical professionals.

Medical Episode Grouper

The Medical Episode Grouper (MEG) enables government agencies to analyze patient treatments, evaluate quality of care, and manage associated costs. It does so by grouping inpatient, outpatient, and pharmaceutical claims into clinically homogeneous units of analysis called episodes that describe a patient's complete course of care for a single illness or condition.

DataProbe

A data analysis and decision support system, DataProbe enables analysts, researchers, investigators, and other knowledge workers to rapidly perform complex, multi-step, iterative investigation on various types of detail data from different sources.

Consulting Services

Truven Health Analytics has the knowledge, the resources, and the consultative experience to help government agencies balance the cost and quality of healthcare within the constraints of the fiscal environment. Our experience with multiple federal agencies enables us to provide unique insights for addressing specific program needs. Our benchmarks help agencies better identify opportunities for program redesign and improvement, while our proven clinical and analytic methods ensure the information is reliable.

Prepay and Prevention Investigative and Consulting Services Predictive Analytics, Algorithms and Reporting Provider Surveillance Case Management

Prepay & Prevention Investigative Services Provider Surveillance Predictive Analytics Case Management