Data Analytics

Using state-of-the-art data mining and analytical techniques, HWT has developed a suite of clinically and financially focused specialty cost management services to assist healthcare payers identify and recover dollars from overpayments and inappropriate provider billing, determine third party liability and improve various claim payment errors.

Our Data Analytic services are predicated on our experience in constructing large data warehouses that integrate data from multiple sources including fee-for-service claims data, managed care encounter data, Medicare’s enrollment database, eligibility information and healthcare data from other related services areas like mental health and social services. Our data warehouses are routinely updated with monthly or quarterly claims data.

Specific areas in which HWT has created cost management programs that have led to significant financial recovery and enhance program management include:

• Decision Support Systems — The core of HWT’s Decision Support System solution is our web-based iQSuite data mining and reporting tools.
• Drug Rebate —HWT has recovered millions of dollars through J-Code and other drug rebate audits.
• Third Party Liability — HWT offers a range of TPL identification and recovery services.
• Retiree Medicare Optimization — HWT’s Retiree Medicare Optimization services scrutinize retiree health are claims to ensure that employers are maximizing Medicare benefits opportunities.
• Disease Management Program Evaluation — By looking at patient-specific medical, institutional and pharmacy claims data, HWT can help payers focus on where interventions can be made. Once disease-specific interventions are implemented, HWT can further assist by conducting follow up analyses that assess and quantify the outcomes disease management programs.