Empowered Information Systems Claim Analyzer

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Empowered Information SystemsClaim Analyzer

• Empowered Information Systems
• info_at_empoweredinformationsystems.com
• www.empoweredinformationsystems.com

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Analysis Process using Data Warehouse

• Data Warehouse is a repository to store business
  information and structured to
• Facilitate fast retrieval of consistent standard
  and ad hoc reports
• Apply enterprise or customized business rules
  that cannot be applied to source systems
• Conform data structures to enable enterprise to
  adapt to future business changes

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Analysis Process using Data Warehouse (cont)
State Systems
Vendor Apps
Other Sources
Load database Operational Data Store
Presentation Database
Analyses/ Reports
Data Sources
Extract, Transform, Load (ETL) and Analysis
Processes
Load and Transform Data, Apply Business Rules
Explore and Discover
Spent 40-60 of the project resources
Ad hoc reports provide 50-80 of data discovery
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Cycle of the Data Analysis Process

• In todays information age where vast amounts of
  raw data are being captured everyday, the
  challenge is to process the data as fast as
  possible and transform it into actionable
  information.

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The Audit Process - Claim Analysis Context
Work Plan
Planning1
Data Collection Analysis

OARS
Claim Analysis
Survey1
OARS

Survey Result
Claims
AFCARS

Services
Eligibility
MOA
Data Collection Analysis1
Physical

Analytical
Reporting1
Work Plan
Findings

OARS
1Source The Audit Process, January 2005, Office
of Inspector General.
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Challenges of Claim Analysis

• Business intelligence solutions are costly, may
  only address the 40-60 ETL workload, and
  impractical when used only in a single unique
  project.
• Understanding business edits and transformations
  are getting harder and more complex to recreate
  without consuming significant amount of resources
  and time.
• Random sampling in use may result only in
  penetrating 5-20 of the total data patterns.
• Vast amounts of information and data to process
  (i.e. millions of records) given a short period
  of time can be taxing and increases pressure on
  the analyst.
• Analysts may have limited IT resources needed to
  perform comprehensive analysis.
• Technology advancement is based on what is
  available in the current market that may not
  necessarily be effective (i.e. soundex matching
  algorithm).

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Preview
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Define Your Data Leave Technical Coding to
Claim Analyzer

• Define only your claim information including
  claim identity, facts, and other business
  information
• You only need to worry about your data
• No programming! The Claim Analyzer does the
  programming for you!

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Click And Run - Simple Yet Efficient, Elegant Yet
Effective

• With just a simple click, a whole new business
  intelligence and data warehousing processes is
  automatically built and run for the user
• Set-up and run in hours, not in days
• Unleash the power of information technology and
  let it work for you-- doing the analysis against
  millions of records

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Our teams previous combined experience in
healthcare billing for different state agencies

• These systems generated hundreds of millions of
  dollars of paid claims for different states that
  passed federal and state audits.
• Some of these systems were used as base systems
  on other state projects and in turn, generated
  millions of dollars of paid claims.

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EIS Team Credential

• Combined team IT Experience 40 years
• Medicaid/Medicare Data Analysis Experience 7
  yrs
• Medicaid/Medicare Data Volume 300GB or approx
  20M claim/service/eligibility records per
  quarter
• Number of state billing/data warehousing/claiming
  systems designed 10
• Minimum amount of paid claims generated for a
  single system 4M
• Systems estimated total data value 1.8B
• System estimated total claims value that passed
  federal/state audit 300M
• Derived systems (School/TCM/IV-E) that passed
  federal/state audit 200M
• Number of States Served 10
• Team certifications MCP/MCSD/MCAD/MCTS

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Quick Recap
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Summary

• Lead new effective ways to perform claim analysis
  and not just simple random sampling with unsure
  results
• Accomplish more with less with intuitive screens
  and Empowered Information Systems (EIS) data
  analysis technologies.
• Control and minimize audit risk using the
  powerful proprietary EIS technologies including
  EIS Phoenix Data Match Technology.
• Find assistance in writing report using high
  level analysis reports, integrated analysis
  reports and more.
• Find conditions and understand the cause quickly
  and easily either using high level views or
  detailed record level analysis.
• Perform the analysis and set to run just in
  hours, not in days.
• Analyze millions of not just claims, but services
  and eligibility information for comprehensive and
  integrated analysis.
• Designed to process millions of records using a
  decent workstation resources instead of spending
  multi-million dollars in state-of-the-art
  multiple CPU servers.

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Top 5 Business Benefits

• Increased Productivity. It enables user to
  perform the analysis on the fly.
• Reduced Cost. Data are analyzed without
  consuming large part of the IT budget.
• Better Communication. With detailed analysis
  report, users can see all the information
  pertinent to the claim.
• Improved analysis service. Performing integrated
  analysis provides wider range of coverage.
• Streamlined analysis process. Seeing the holistic
  view can substantially assist in understanding
  areas that require more advance analysis.

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Thank you!

• Comments, suggestions, and/or questions, please
  send to
• Attention Product Manager
• Info_at_empoweredinformationsystems.com
• Empowered Information Systems