Provider Integrity Scan

Screen your providers with confidence to reduce risk and prevent fraud.


Billions of dollars are lost each year through fraud and improper payments to providers.

To prevent the risk, Centers for Medicare and Medicaid Services (CMS) has established requirements to validate their networks. As Pharmacy Benefit Managers (PBMs) bear the brunt of this risk assessment, the need for accurate, actionable information has never been greater.

 

LexisNexis® Provider Integrity Scan automates a variety of provider verification searches and ongoing monitoring options by checking against multiple files and lists, and provides automatic red flag alerts for a wide range of high-risk indicators. It has the capability of screening and verifying pre-enrollment as well as monitoring post-enrollment to detect and prevent criminal activity.

provider integrity scan


Benefits

LexisNexis® Provider Integrity Scan is designed to help reduce health care payers' and PBM's costs by identifying potentially fraudulent providers and businesses enrolled or attempting to enroll in health-related programs. Our solution gives users the ability to efficiently process multiple searches and obtain critical information contained within massive volumes of data from verification of data to risk scoring and fraud indicators.

  • Ensure that only trustworthy professionals provide care in their network through verification of crucial information that is currently self-reported
  • Automate enrollment processes through streamlined verification of documents, with consolidation of numerous checks. Utilizing its industry-leading data assets and sophisticated matching capabilities, LexisNexis Risk Solutions is able to resolve identities with confidence. We offer multiple delivery channels to minimize changes to current workflow process and improve overall efficiency
  • Comply with CMS mandates that Medicare, Medicaid and CHIP providers be screened for their risk of committing fraud before being allowed to enroll in federal programs


Features

provider integrity scanLexisNexis® Provider Integrity Scan leverages advanced data technology to assist healthcare payers in both the private and public sectors in verifying and monitoring healthcare provider licensing and credentials, and detecting and preventing fraudulent or criminal provider activity.

  • Result delivery via batch or XML
  • Ability to process multiple searches and obtain the critical information contained within massive volumes of data.
  • Provider information, credentials and alerts including:
    • Deceased information with date of death
    • Provider file monitoring for risk indicators between enrollment periods.
    • License status
    • Sanctions
    • Criminal convictions
    • High risk indicators for address and SSN
  • Financial information such as liens, bankruptcies and judgments
  • Provider business ID verification

Get it now: For more information about LexisNexis® Provider Integrity Scan, call 800.869.0751.

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LexisNexis® Provider Integrity Scan does not constitute a “consumer report” as that term is defined in the federal Fair Credit Reporting Act, 15 USC 1681 et seq.(FCRA). Accordingly, LexisNexis Provider Integrity Scan may not be used in whole or in part as a factor in determining eligibility for credit, insurance, employment or another permissible purpose under the FCRA. Due to the nature of the origin of public record information, the public records and commercially available data sources used in reports may contain errors. Source data is sometimes reported or entered inaccurately, processed poorly or incorrectly, and is generally not free from defect. This product or service aggregates and reports data, as provided by the public records and commercially available data sources, and is not the source of the data, nor is it a comprehensive compilation of the data. Before relying on any data, it should be independently verified.