This includes completeness, referential integrity, usability, and stability to identify specific problems in client and third-party source data.Our industry experts are happy to provide an in-person or web conference overview that is customized to your organization and your needs. Pondera’s system provides payment integrity services through pre-payment and post-payment analytics on providers, beneficiaries, claims, and members for both fee-for-service and managed care organizationsAll aspects of Pondera’s system are built to handle the massive data sets found in healthcare including smart link charts to view large networks of providers and beneficiaries/members, and scorecards to triage leads and prioritize enforcement activities.Pondera combines hundreds of healthcare-specific detection algorithms to identify issues such as doctor shopping for opioids, duplicate payments, unbundling, up-coding, unnecessary procedures, and unusual travel patterns. Managers can access program statistics on leads, cases, and overall team performancePondera’s CaseTracker™ allows managers to easily track and manage cases and case files, get detailed team performance metrics, top alert violations, percentage increases, and important program information. With pre and post payment surveillance, provider and beneficiary/member review, and a full array of analytics and third party data to augment your claims and encounter data, the Pondera solution provides cutting-edge Fraud, Waste and Abuse monitoring. The new case management system has improved business processes and data gathering for the 366B. Review return on investment by month, quarter, or yearPondera ingests your program data, matches it against third party data sources, and then runs it through a series of procedural and prediction models to detect previously known and unknown anomalies and patterns.Program data and 3rd party data are ingested and run through procedural and prediction models to detect previously known and unknown bad actors, schemes, and patterns. The mobile application allows field investigators to review, record, and track cases while in the field.Pondera analyzes the fitness of your data specifically for its use in fraud detection analytics. Using a combination of third-party databases, rules-based analysis, prediction algorithms, and machine learning, the system can help federal government agencies validate program beneficiaries, service providers, and discrete transactions. It can also be used post-payment as a detection, investigation, and enforcement system including fully integrated case management functionality.
Pondera can be used for both pre-payment and post-payment program integrity enforcement.
We are therefore well acquainted with all laws and regulations that a maintenance party and supplier manager must meet.
Data is vetted prior to analysis with our proprietary data profiler tool and assessed for completeness, efficacy, consistency, and usefulness.Fully-integrated investigative case management imports cases from the fraud detection module or other sources and uses workflow and rules engines to route cases through your resolution process. Pondera’s cloud based integrated messaging system enables teams to share cases, files, and profiles within the dashboard and to create notes for profiles, alerts and casesMeasure case outcomes including cases pending, opened, and closed. Using team performance analytics, managers can allocate program integrity resources and view the results of their enforcement … Pondera is built on a scalable, modular architecture that can rapidly analyze the massive data sets found in many federal government programs.
As a result, Nevada’s investigation and recovery team is more efficient and effective.” BILL STRONG – Chief of Investigations and Recovery, It can also be used post-payment as a detection, investigation, and enforcement system including fully integrated case management functionality.Pondera can help you validate both beneficiaries/members and providers using third-party data, applicant data, and ongoing behavioral analysis. This includes functionality for eligibility validation, provider analysis, and suspicious claims/encounter detection.Pondera can be used for both pre-payment and post-payment program integrity enforcement. Using team performance analytics, managers can allocate program integrity resources and view the results of their enforcement actions.Managers use FraudCaster® to review Trends, patterns, clusters, and individual leads with their team with a comprehensive view of program participant’s eligibility information, alerts, behaviors, and transactions.Our Special Investigations Unit provides intel reports to help support your efforts in particularly complex casesCase management system integrates fraud alerts and enables workflow, case tracking, and reporting
Pondera’s fully integrated case management system, CaseTracker™, manages case information, reports on case status and investigator progress, and feeds the results back to the front-end analytics to continually improve detection accuracy
Pondera’s CaseTracker™ allows managers to easily track and manage cases and case files, get detailed team performance metrics, top alert violations, percentage increases, and important program information. This helps the government …
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pondera case management