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Detection Software

Ingenix Detection Software solutions help payers prevent inappropriate medical expense payouts and feature facility and professional claims editing capabilities, subrogation detection, and a table-driven knowledgebase of edit rules.

Detection Software helps you:

  • Prevent payment on erroneous claims
  • Discover potentially fraudulent claims
  • Recover overpayment losses

Products:


Claims Editing KnowledgeBase
With clinically sourced and documented edit rationales for more than three million code-to-code relationships, the Ingenix Claims Editing KnowledgeBase improves efficiency and accuracy of claims processing.
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Fraud and Abuse Detection
We are established experts in detecting, preventing, and recovering overpayments due to fraud and abuse, incorrect coding, third party responsibility or liability, and simple errors. We have developed one of the most comprehensive set of solutions available.
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iCES: Ingenix Claims Editing System
Ingenix Claims Editing System is an open-architecture claims editing tool that offers full disclosure of rules-based edits. The browser-based application and database expands your claims transaction system's capabilities with valuable new utilities that reduce manual review and promote more consistently appropriate reimbursement with attendant cost savings.
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