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