Retrospective Investigation and Recovery Services

As an established leader in the field, Ingenix offers comprehensive retrospective fraud detection development and recovery services that include all aspects of the process—from the initial referral receipt to the final recovery settlement.

Select the services that most effectively support your needs, from an augmentation of internal efforts to a full outsourcing solution.

Overview

Maximize your investment

While most health care payers have deployed traditional “pay and chase” strategies to identify charges lost to fraud and abuse after the claim has been paid, the investments in expertise and technology needed to effectively perform successful case development and recovery efforts are considerable. Let Ingenix help you detect and recover claims overpayments resulting from fraud and abuse.

To fully develop a case, we perform services such as:

Medical record audits
Provider verification
Trending
Financial loss quantification
Department of Insurance (DOI) reporting

Recovery

Following case development, an evaluation is performed on each case to determine the strategies for further overpayment recovery actions. For cases that progress into the recovery stage, an experienced team of professionals then perform a deeper level of investigation, coordinate recovery negotiations, agree upon and arrange settlement agreements, recover dollars, and finally, present a check to you.

The value of experience

We have reviewed aberrances and/or referral allegations associated with 1.4 million providers and 20 million members on more than 200 million claims, bringing extensive knowledge to the process.