ATLANTA – LexisNexis® Risk Solutions is featured in Aite Group’s “Health Insurer Fraud and Payment Integrity Solutions” Impact Report as a payment integrity and fraud analytics vendor whose solutions help health plans better understand their member risk and help uncover sophisticated fraud, waste and abuse (FWA) schemes.
The research aims to help plans evaluate analytics solutions to increase the scope of FWA detection as payers are transitioning payment integrity from an operational imperative to an enterprise-wide core competency.
Combining cutting-edge technology, unique data and advanced analytics, LexisNexis Risk Solutions provides solutions and services that address evolving payer needs in the risk sector while upholding the highest standards of security and privacy. The company’s health care solutions help: verify patient identity and eligibility, validate and maintain provider and patient information, identify FWA in claims, predict health risk and improve outcomes, all while promoting cost containment and health plan compliance.
“LexisNexis Risk Solutions is uniquely positioned to add further value, helping health plans manage and transform new, large, diverse streams of relevant public, consumer and claims data and transforming analytics from a commodity-claims-based capability, such as blending its identity-management detection with its analytics platform,” said Michael Trilli, Senior Analyst with Aite Group. “Innovative companies, such as LexisNexis Risk Solutions, offering well-rounded payment integrity solutions can be attractive considerations for health plans.”
LexisNexis Risk Solutions is unique in its capability to aggregate a wide range of data and apply advanced analytics to link disparate files to flag suspicious claims. The database includes claims data such as high-volume dollars; provider data such as locations and affiliations; individual member data such as criminal background and bankruptcies; business data, such as liens or judgments; and non-healthcare data such as identity fraud or auto insurance accident history. The ability to look beyond their own data helps plans uncover more complex schemes due to organized crime rings.
In addition, the company is a leading provider of solutions to prevent and detect fraudulent Affordable Care Act marketplace enrollments, which created new fraud opportunities via brokers enrolling ineligible or fictitious people.
About LexisNexis Risk Solutions
LexisNexis Risk Solutions harnesses the power of data and advanced analytics to provide insights that help businesses and governmental entities reduce risk and improve decisions to benefit people around the globe. We provide data and technology solutions for a wide range of industries including insurance, financial services, healthcare and government. Headquartered in metro Atlanta, Georgia, we have offices throughout the world and are part of RELX (LSE: REL/NYSE: RELX), a global provider of information and analytics for professional and business customers. For more information, please visit www.risk.lexisnexis.com and www.relx.com.
About Aite Group
Aite Group is a global research and advisory firm delivering comprehensive, actionable advice on business, technology, and regulatory issues and their impact on the financial services industry. With expertise in banking, payments, insurance, wealth management, and the capital markets, we guide financial institutions, technology providers, and consulting firms worldwide. We partner with our clients, revealing their blind spots and delivering insights to make their businesses smarter and stronger. Visit us on the web and connect with us on Twitter and LinkedIn.