Guided Analytics

Intuitive Analysis Prompts Actionable Insights.

Reveal new insights into your data with HMS’s Guided Analytics. The module is part of HMS’s complete offering to meet your needs: Fraud Solutions.

Truly meant to “guide” users, HMS’s Guided Analytics use a set of behavioral scenarios, statistical models, and algorithms to identify potential high-risk targets. Upon receipt of new data, each analytic is pre-executed so the most up-to-date information is always readily available. Subsequent drill-down tools and data dashboards allow you to follow pre-constructed logical paths to learn and understand the potential impact of the findings. As a result, you can focus on cases that are most likely to yield the highest return – either fraud prevention or recovery.

Our experienced, accredited fraud investigators and clinical professionals built each of our guided analytics to address specific risk issues. From anomalies in payment patterns to high-cost drug prescription usage, each model reviews available data and offers a list of targets with suspect behavior based on the model criteria. The drill-down analytic tools applied to the initial targeted providers and members move the findings from a list of targets into a list of validated leads.

The Guided Analytics easy-to-use interface simplifies target identification. Prompts guide you through the analysis process to known conflicts, while new watch and alert features help you monitor questionable subjects without having to comb through numerous reports.

Guided Analytics also works cross functionally with other Fraud Solutions modules into a cohesive solution: Link Visualization, Lead Management, Case Management, Provider Scoring, Member Scoring, and Advanced Search.

HMS’s Guided Analytics enables even a novice to efficiently analyze data and take rapid action. You can be confident our analytics are continually updated to stay current with industry trends, schemes, and scams – keeping you ahead of the fraudsters.

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