Payment Accuracy

HWT’s Payment Accuracy Services are designed to increase the accuracy rate of the claims payment process and assist payers in preventing unnecessary healthcare expenditures.

Combining advanced data mining technology, rule-based algorithms, sophisticated pattern detection and statistical analysis, HWT identifies improperly paid claims (provider-initiated fraud, waste and abuse) and excessively paid claims (claims paid in excess of established polices and procedures). HWT's experts also identify vulnerabilities in "upstream" payment policies and systems, and make specific recommendations for changes to prevent future losses.

HWT’s comprehensive review encompasses all claims and provider types across multiple years, enabling identification of patterns and trends across providers. Typical areas of findings include:

• Unreasonable Quantities
• Unbundling of Services
• Duplicate Reimbursement
• Pharmacy Errors
• Provider/Service Mismatch
• Inappropriate Reimbursement for Provider Type
• Prolonged Services
• Mutually Exclusive Codes
• Claims After Death