OVERVIEW: Admiral Health
American National Healthcare Anti Fraud Association reports that insurers loose between 3% and 10% of all the healthcare expenses to fraud. The situation in Europe is no less worrisome. The British National Health Service Counter Fraud Service claims that every year shocking 30 to 60 billion Euros are lost in the EU in our national healthcare systems due to anomalies, fraud and abuse.
Due to the complexity of the healthcare systems, the processes and the large number of participants, it is very difficult to screen healthcare systems for fraud. Frauds occur in different forms, and are conducted by different participants of the healthcare process: patients, suppliers of medicine and medical technical devices, and medical service providers, etc.
Not only do we help insurers reduce fraud in the narrow sense, but also flosses caused by anomalies, bad practices, errors, irregularities, abuse and poor control.
The software has been built specifically for fraud management teams in health insurance and fits the process perfectly. With an ergonomic user interface and our effective tool training programs, the investigator can easily check tens of thousands of healthcare services per year.
MORE THAN A SOFTWARE VENDOR
Not only do we bring a software platform, but we also bring experience team of professionals from different medical areas of expertise, experience investigators and lawyers, that will help insurers with any type of fraud management related tasks.
We connect our solutions to relevant actionable information from various professional medical sources. Some sources are country-specific, or even hospital specific, such as pricelists and regulations. Admiral Health will automatically cross-check insurers’ claims with the available information to ascertain, whether the claims are medically justified and if they were charged for properly.
Download the product information.
Complete fraud management tool tailored for health insurance
Healthcare fraud takes different forms. In some cases it is medical inconsistencies, where services rendered were not medically justified. Admiral Health will advise you on where redress is possible, and which cases to focus on. In case of technical inconsistencies in services rendered (such as prices, amounts, etc.) Admiral Health will automatically dispute the discrepancies. It will also warn you about systemic frauds, which cause big losses. Additionally, the system will follow your claims management process by keeping track of the procedural deadlines in the claims handling process.
Celent, the leading research and consulting firm within the global financial services industry, issued its report on Health Insurance Claims Fraud Detection Systems: 2015 IT Vendor Spectrum, identifying TOP global IT providers in the field of health and medical insurance claims fraud detection. Their selection of 13 global vendors included Optilab’s Admiral Health, the fraud management solution for Health Insurance Companies.
CELENT, research and consulting firm
Matjaž Trontelj, General Manager Department of Insurance Contingency and mag. Katja Pečlin, Head of Department for Processing Insurance Claims, both from Vzajemna health insurance – the first and the largest voluntary health insurance company in Slovenia – presented the internal organization of their fraud management department, emphasizing the crucial role of the Admiral application within their processes at 5th Admiral Users Conference.