We offer comprehensive verification, validation and authentication tools in order to help health insurers combat fraud and protect their organizations.
Verify the identities of providers and suppliers
Minimize risk and prevent improper payments by verifying the identities of health plan members, providers, and suppliers. InstantID® searches both business and consumer records to verify such essential data as name, address, and social security or Federal Identification number, and it alerts you to indicators of identity theft or fraud.
Order medical records
LexisNexis® Medical Records Retrieval offers a fast, convenient way to order records and verify your customers’ medical histories. Our secure, web based interface allows you to request orders and to view the status of each request in real-time, 24 hours a day, seven days a week. We also offer additional research services whenever you suspect that a customer has omitted crucial information.
Improve your collections and subrogation efforts
Recover assets and settlements and increase revenue with LexisNexis® Collections Management solutions. This powerful suite of tools helps you investigate debtors and uncover any potential third-party liability for claims payment, whether partial or in full.
Prevent and investigate fraud
Reduce the risk of health care fraud and abuse with Accurint® for Health Care, a powerful tool that helps verify and validate the professional licenses of health care providers nationwide. Such in-depth information as board certifications, DEA licensing, legal standing, criminal records, and licensing entities are available. Accurint’s sophisticated linking technology can also reveal undisclosed relationships between patients, providers, and medical facilities.
In order to allow National Health Care Anti-Fraud Association (NHCAA) members to collaborate with one another and share critical information on suspected fraud and abuse cases, LexisNexis® Risk & Information Analytics Group has re-engineered the Special Investigation Resource and Intelligence System, or SIRIS. SIRIS data includes useful descriptions of health care fraud schemes and trends as well as searchable information on individual cases.
Find new customers
We offer a variety of direct marketing solutions to help you find new customers and expand your business. Targeted Consumer Lists provides you with accurate, relevant consumer data in order to help you locate the very best prospects. With Data Enhancement, you’ll learn more about your current customers, identify look-alikes to your best responders, and generate broader and more successful marketing campaigns. And Data Hygiene can help you optimize your address files, detect name changes, and create a complete, single customer view for up- and cross-selling.
Screen prospective employees, volunteers and contractors
Compete for and hire the most qualified staff—faster.
Whether you are an HMO, an insurance company, a hospital network, or an extended care facility, LexisNexis® Screening Solutions for the healthcare industry can help you:
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Maintain critical compliance requirements in a rapidly changing
legislative environment. |
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Streamline and accelerate your hiring processes by integrating with
your current human resource information system. |
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Easily accommodate high volume hiring peaks, in which you must screen
and hire a large volume of workers for specific projects at
different locations. |
Background checks for healthcare workers
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Process and investigate claims more efficiently
LexisNexis® Claims & Utilization Review Solutions enable you to process and investigate claims more efficiently to reduce financial losses, decrease expenses and make more informed decisions to improve profitability.
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Enable automatic review of each claim to ensure data accuracy with solutions that quickly process large volumes of data and confirm, append or update key data elements, including addresses and National Provider Identifiers. |
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Identify suspicious claims early in the review process with online verification of key patient and provider information, including bankruptcy filings, criminal records, as well as determine provider assets to assist with recovery efforts. |
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Shorten the investigative process through integrated solutions and proprietary, data-linking technology that returns detailed search results to the user’s desktop in seconds. |
Process and investigate claims more efficiently
Download Brochure (PDF, 960K)