Ingenix Detection Software

Ingenix Detection Software helps payers prevent inappropriate medical expense payouts and features Facility Claims Editing capabilities that enable payers to fully monitor outpatient, and soon, inpatient facility claims.

By prospectively monitoring and editing facility claims, payers can catch errors, fraud, and abuse and save up to 2―5% of facility claims payout.

Overview

Revolutionary Tool

With rich management features including customized rules creation and modeling and comprehensive reporting tools, Ingenix Detection Software for Facility Claims is the industry’s first fully-featured facility claims editor and is being implemented by major health plans today.

Detection Software helps:

Prevent inappropriate medical expense payout
Improve medical expense costs
Identify savings opportunities
Apply Medicare rules to commercial facility claims

Facility Claims Editing capabilities

Ingenix Detection Software (iCES™) now features Facility Claims Editing capabilities that enable payers to fully monitor outpatient, and soon inpatient, facility claims. By applying highly defensible rules (as appropriate) to commercial claims, payers can achieve immediate savings up to 2―5 percent of facility claims stream without renegotiating contracts.

Medicare APC editing

The system’s highly defensible facility editing rules are based upon published Medicare guidelines. Ingenix offers a unique Commercial Template that enables to payers to apply highly defensible rules to commercial facility claims and achieve immediate savings without renegotiating facility contracts.