Healthcare Companies Achieve Significant Savings with FraudScope’s New Provider Scope, an Online Provider Self-Monitoring Portal

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AI-powered solution proactively analyzes provider, facility, and pharmacy coding behavior to identify outliers and educate providers about coding best practices

FraudScope announces the launch of Provider Scope, a new solution for health plans that analyzes professional, facility, and pharmacy claims and coding practices to quickly identify outlier behavior, promote coding best practices, and reduce costs pre-claim.

Provider Scope’s artificial intelligence-driven technology empowers health plans with actionable insights about claims behavior so they can proactively engage providers to improve claims accuracy. Accessible through an interactive online portal, Provider Scope enables providers to self-monitor outlier behavior relative to their peers and to communicate with certified coders to learn about best practices. The results are generated using FraudScope’s patented AI platform that analyzes claims history and other data sources to understand behavioral norms and make it easy for providers to understand and visualize their outlier behavior.

“As healthcare costs continue to rise, our team continuously seeks new ways to empower health plans to monitor and contain costs,” stated Musheer Ahmed, CEO of FraudScope. “We developed Provider Scope to give health plans much-needed insights into the billing practices of their professional providers, facilities, and pharmacies. Provider Scope is a first-of-its-kind solution that helps healthcare companies and agencies improve claim accuracy while avoiding provider abrasion, bringing new levels of transparency to these groups.”

Instead of relying on broad coding guidelines sent out to their provider networks, health plans can now use Provider Scope to engage specific providers based on their actual claim patterns. Sharing the comparative coding practice data gives providers the information they need to bring their coding in line with best practices.

Unlike other provider education offerings that only analyze a small subset of simplistic codes and are limited in the information shared with providers, Provider Scope’s AI platform analyzes complex codes and shares additional information with providers to allow them to self-monitor and track their own progress. This is especially valuable for health plans that are inundated with numerous cases and would benefit from the automated nature of Provider Scope to manage outlier provider behavior, allowing their teams to focus on the most egregious cases. Through Provider Scope, plans can drive significantly larger savings with their existing staffing levels.

Provider Scope is available now with risk-free early adopter pricing and no-cost implementations for initial customers. To learn more or request a demo, visit us at https://www.FraudScope.com.

About FraudScope
FraudScope is a leading provider of artificial intelligence-driven applications that help healthcare companies and agencies control costs by identifying and investigating fraud, waste, abuse, and other anomalous cost drivers. The Fraud Scope, Insight Scope, and Provider Scope applications are built on our Forensic AI Platform, which analyzes existing claims data, detects practices that intentionally or unintentionally increase costs, and builds connections across the data to provide actionable insights. Our Software-as-a-Service applications are HIPAA-compliant and operate in a HITRUST-certified environment.

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Ronda Duncan
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