LexisNexis Intelligent Investigator™ is a rules-based overpayment detection system that pinpoints suspicious behavior across all health care claim types, including medical, facility, pharmaceutical and dental. Intelligent Investigator’s easy-to-use interface allows users to trace leads by provider, member/patient and transaction. Its advanced drill-down feature lets users drill all the way down to a comprehensive Patient History snapshot. Diagnosis, physician visits, inpatient stays and prescription usage are presented in this view.
LexisNexis® Intelligent Investigator™ advanced drill-down feature allows users to trace leads by provider, member/patient, transaction and other related data with ease. Special screens have been built in to assist investigators in identifying providers or claims based on partial information or tips off fraud hotlines. The user-friendly system also supports usage by non-investigative departments such as provider relations, medical directors, finance and audit among others.