• Leveraging data analytics and advanced investigative tools to uncover potential FWA 

• Demonstrating the value of predictive modelling in targeting suspicious providers and claims 

• Coordinating the efforts of credentialing/enrollment, audits, investigations (SIUs), provider sanctions, and policy 

• Very few insurance payers have all those groups working together in a coordinated effort to reduce fraud, increase revenue, and render excellent customer service to enrolled health care providers. 

• Importance of accurate and complete clinical documentation 

• Addressing common coding challenges and complexities faced by providers,  

• Driving revenue integrity with a robust CDI program 

Details TBC