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State Claim Edits and Analytics

Find Fraud, Waste, and Abuse Faster.

Claim Edits and Analytics
At HMS, our Claim Edits and Analytics use the broadest range of post-adjudication and post-pay edits to review claims for error and potential abuse. They are customized to federal and state regulations, and to your own policies.

It’s all part of HMS® Improper Payment Prevention, your complete solution for fraud, waste, and abuse. Our analytics create claim-level breakdowns of improper billing issues and statistical/anomaly pattern analysis to help you spot suspicious trends. HMS’s dashboards and provider scorecards help you quickly identify, prioritize, and review high-risk providers, members, and services.

HMS’s link visualization module uses an industry-leading interface to show providers and members as nodes in the system. Clicking on a node shows relationships with other nodes – such as shared address, geographic concentration, and physical location – with map and street views. Using our pre-built scenarios, you can quickly target potential issues.

Fill out the Contact form to find out more about HMS Claim Edits and Analytics.