What’s The Nightmare of Health Insurance Payers?

http://www.linkedin.com/today/post/article/20140609051957-81673076-what-s-the-nightmare-of-health-insurance-payers?trk=mp-details-rr-rmpost

Teleauditing of medical claims

as outsourcing facility for auditing medical claims at level of Approval & Regection

In business, outsourcing is the contracting out of a business process to a third-party. The term "outsourcing" became popular in the United States near the turn of the 21st century

why outsourcing facility (why TAC)?

Companies primarily outsource to avoid certain costs - such as peripheral or "non-core" business expenses, high taxes, high energy costs, excessive government regulation/mandates, production and/or labor costs

outsourcing facility (TAC) as 3rd party provides services for both insured and insurer

in professional way with high quality services with resonable cost

system and method for detecting #fraudulent #medical #claims via examination of service codes

system and method for detecting fraudulent medical claims via examination of service codes

US 5253164 A

summary

An expert computer system for processing medical claims. Medical claims and associated representation are inputted into the expert computer system. The inputted claims are interpreted according to specific rules and against a predetermined database to determine whether the medical claims are appropriate.