Claim Scoring

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Performant leverages a proprietary predictive scoring algorithm to prioritize claims with the highest probability of error, allowing medical record requests and audits to be focused on providers with high error rates and minimizing disruption to providers with higher billing accuracy. The scoring algorithm benefits from our years of national experience, providing high-quality audits the nationwide.

The scoring and selection process supports four primary objectives:

  1. Identify claims payments with the highest likelihood of error
  2. Target improper payments and fraud more accurately
  3. Manage and optimize results within HSD-defined ADR limits effectively
  4. Reduce and mitigate unnecessary provider burden

Scoring and selection is compromised of the following elements:

  • Flagging claims for potential audit
  • Predictive scoring of flagged claims
  • Optimized selection of claims for audit