NEWTON, Mass., February 20, 2013 — The National Healthcare Anti-Fraud Association estimates the waste, abuse and fraud problem in the U.S. healthcare industry at 3% of total costs. As payers seek new ways to address the issue, McKesson has seen increased interest in its proactive technology solutions that emphasize pre-pay prevention rather than inefficient “pay and chase” processes. In 2012, the company signed two new clients for InvestiClaim, its enterprise waste, abuse and fraud management system, and five new clients for its ClaimsXten Waste and Abuse KnowledgePack claims editing rules. Several additional clients went live with the KnowledgePack in 2012, including Health Alliance Plan of Michigan.
“In navigating new, more complex payment models, payers face even greater challenges in ensuring that dollars are spent appropriately. Flexible, advanced reimbursement solutions are essential to maintain payment integrity while enabling innovation and containing administrative costs,” said James Evans, vice president of financial and network management at McKesson Health Solutions. “Our clinical editing content and advanced technology paired with neural analytics represent a more intelligent approach to waste, abuse and fraud prevention that helps payers stay on top of emerging payment risks.”
McKesson’s comprehensive payment integrity solutions help payers address all known issues of waste and abuse up front with pre-pay claims editing rules, while pre- and post-pay neural analytics provide another layer of detection for unknown or emerging issues. Importantly, because both payment integrity solutions are integrated on the McKesson Total Payment platform, they form a continuous improvement loop in which reasons for unknown waste or abuse found in the neural analytics can be quickly addressed with new policies or editing rules.
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