U.S. healthcare insurers and providers collectively lose
billions of dollars annually to fraud, waste, and abuse (FWA) with
an estimated four to ten percent of all health insurance claims
containing FWA. CTG's CAMS-Medical Data to Optimize Claim Dollar
Savings detects FWA patterns for investigation at significantly
higher rates than those of standard brute-force data mining systems
by combining sophisticated business intelligence software with an
advanced targeting methodology. This architecture builds a
comprehensive multi-source knowledge base that integrates advanced
rules-based FWA targeting, provider and payer claim codes, medical
expertise, and provider data to flag FWA and recommend actions. In
addition to enhancing FWA detection, case building, and revenue
recovery, CAMS is highly effective in identifying billing errors
and efficiency opportunities.
CAMS' unique, high value differentiators
- Industry Experience and Technical Expertise
The CAMS development and consulting team includes audit and
compliance experts, hospital clinicians and administrators, and
technologists, all with significant healthcare and insurance
industry knowledge.
- Flexible, Scalable System that Stores
and Reuses Patterns for Investigation CAMS uses layered
inference engines that can provide five to ten times the amount of
information after inference, enabling patterns for investigation to
be stored and reused over time while also identifying new forms of
FWA.
- Integrated Solution CAMS can be integrated
into both financial systems and patient-centered outcomes software
helping you compare providers/programs to determine value-based
outcomes.
- Portal Access, Flexible Reports CTG's approach
uses a web-based portal that users can access from anywhere. CAMS'
cutting-edge semantic technologies support user-friendly reports
that are easy to reuse and repurpose.
- Customized Approach CAMS is not a
"take it or leave it" out of the box solution, but a tailor-made
one adapted to fit each client's specific needs.
- Interfaces with Existing Systems/Software
There is no need to purchase new hardware or abandon existing tools
to use CAMS.
- Advanced Analytics CAMS provides advanced
analytics in the form of real biomedical information (e.g.
SNOMED-CT, LOINC, etc.) giving claims auditors access to real
medical terminologies that are useful in examining claims and
reducing the need to perform repetitive tasks.