State Claim Edits and Analytics

Find Fraud, Waste, and Abuse Faster.

Claim Edits and Analytics
At HMS, our Claim Edits and Analytics use the broadest range of post-adjudication and post-pay edits to review claims for error and potential abuse. They are customized to federal and state regulations, and to your own policies.

It’s all part of HMS Improper Payment Prevention, your complete solution for fraud, waste, and abuse. Our analytics create claim-level breakdowns of improper billing issues and statistical/anomaly pattern analysis to help you spot suspicious trends. HMS’s dashboards and provider scorecards help you quickly identify, prioritize, and review high-risk providers, members, and services.

HMS’s link visualization module uses an industry-leading interface to show providers and members as nodes in the system. Clicking on a node shows relationships with other nodes – such as shared address, geographic concentration, and physical location – with map and street views. Using our pre-built scenarios, you can quickly target potential issues.

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