The Waste Prevention Services offering focuses on medical, facility and pharmacy claims where TriZetto analysts prospectively and retrospectively:

• Identify patterns and schemes indicative of potential waste
• Review identified suspect claims to verify that overpayments will or have been made
• Resolve inappropriate claims through prepayment denial and retrospective overpayment recovery
• Prevent future overpayments through education, corrective actions, and support of network management efforts

How it Works: We process live and historical claim data through our detection software in order to identify services that don't comply with billing rules. Suspect claims that may require additional review are also identified and reviewed. Output reports are generated that contain summary and detailed overpayment information that allows for quick prioritization and initiation of resolution strategies.

Benefits

• Identifies and helps reduce medical, facility and pharmacy waste
• Educates providers, helping prevent overpayments
• Supports quick prioritization and initiation of resolution strategies