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Description
To mitigate potential risks, the Centers for Medicare and Medicaid Services (CMS) have instituted guidelines to ensure the validation of their networks. Given that Pharmacy Benefit Managers (PBMs) are significantly impacted by the risk assessment process, the demand for precise and actionable insights has reached unprecedented levels. The LexisNexis Provider Integrity Scan streamlines a variety of provider verification processes and offers continuous monitoring by cross-referencing numerous files and lists, while also delivering automatic alerts for numerous high-risk factors. This tool is proficient in screening and verifying providers both before and after enrollment, aiming to uncover and thwart criminal activities effectively. By identifying potentially fraudulent providers and businesses involved in health-related programs, the LexisNexis Provider Integrity Scan serves to lower costs for health care payers and PBMs alike. Our innovative solution empowers users to effectively conduct multiple searches and access crucial information, enhancing their operational efficiency and security. This comprehensive approach not only safeguards the integrity of health care programs but also fosters a more reliable health care environment.
Description
LexisNexis® Trail Tracker™ provides investigators with the ability to strategize for each case, outline necessary actions, document their findings, set reminders, and oversee records. This tool enhances workflows through features like monitoring case statuses, tracking referral tips, assigning claims to relevant departments for assessment, delegating cases to investigators, and managing their workloads efficiently. Additionally, Trail Tracker™ serves as a valuable asset for Special Investigations Unit (SIU) management, facilitating the measurement of investigator performance on various cases, tracking recoveries and savings, and generating reports on the activities of the unit. By consolidating all pertinent information into a single system, it promotes greater efficiency and consistency throughout the investigative process. This comprehensive approach not only streamlines operations but also empowers teams to collaborate more effectively.
API Access
Has API
API Access
Has API
Integrations
XML
Pricing Details
No price information available.
Free Trial
Free Version
Pricing Details
No price information available.
Free Trial
Free Version
Deployment
Web-Based
On-Premises
iPhone App
iPad App
Android App
Windows
Mac
Linux
Chromebook
Deployment
Web-Based
On-Premises
iPhone App
iPad App
Android App
Windows
Mac
Linux
Chromebook
Customer Support
Business Hours
Live Rep (24/7)
Online Support
Customer Support
Business Hours
Live Rep (24/7)
Online Support
Types of Training
Training Docs
Webinars
Live Training (Online)
In Person
Types of Training
Training Docs
Webinars
Live Training (Online)
In Person
Vendor Details
Company Name
LexisNexis
Founded
1970
Country
United States
Website
risk.lexisnexis.com/products/provider-integrity-scan
Vendor Details
Company Name
LexisNexis
Founded
1970
Country
United States
Website
risk.lexisnexis.com/products/trail-tracker
Product Features
Product Features
Investigation Management
Contact Management
Data Management
Incident Management
Reporting & Statistics
Subject Profiles