Saturday, November 15, 2008

Healthcare Payer Analytics

The link is to an article of the healthcare payer/insurance analytics available in the market. There are three categories of analytic services:
  1. Outlier Detection - This area includes claims auditing, fraud and abuse, and Medicare Part D programs.
  2. Predictive Modeling - This area includes HCC reconciliation and Outcomes Research.
  3. Data Mining - This area includes claims processing, Medicare Advantage, and Care Management.

The architecture of the analytics engine allows for individual portals for payer staff, providers, members, and employers. There are over 300 reports. This architecture is compatible with Oracle (OBIEE), Microsoft (SQL 2005 & 2008), SAS Enterprise Data Miner, Business Objects, Hyperion, Cognos, and SPSS Clementine.


If you have any questions contact Alberto at

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