Today’s issue of WorkCompRecap features Mitchell’s release of its new Provider Data Explorer solution, which aims to provide claims organizations with a holistic view of medical provider behavior, allowing analysis of medical provider treatment and billing behaviors to identify irregular activity that may signal fraud, waste and abuse.
Mitchell noted that visual depictions of claims data allow comparison of medical provider behavior to that of their peers, which can be used in a variety of ways, including easily pinpointing outliers in order to help identify potential fraudulent or abusive behaviors. The tool tracks a variety of metrics related to provider behavior, including treatment duration, treatment frequency, billing and adjustment behaviors, and procedure codes that, if incorrect, may disproportionately drive up the charged amount.
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