HEALTH CARE
Friss has developed a vision and a method for application to the health care market which results in significantly more real cases of fraud and wrongfully paid claims being exposed.
This is because it is possible to look at patterns in the complete claim behaviour of the health care provider and/or the insured person.
Integral control process
- The Friss package allows an integral process of signalling up to and including settlement to be supported with the objectives of:
COMPLYING with legislation - Managing the BURDEN OF CLAIMS and making this more transparent
- Moving from incident management to a STRUCTURAL and MANAGEABLE control process on the basis of uniform risk analyses
- The optimum EMBEDDING of control activities within the process
- Achieving central MANAGEMENT of checks within the various control processes (formal, equipment and fraud) establishing a UNIFORM PROCEDURE for dealing with claims that have been paid out and that have been detected as being incorrect
Grip on the control process
Users are able to follow the process of a signal of abnormal claim behaviour from the beginning to the end. The result is presented to the user on a plate. A business case can be prepared simply for each event to show simply whether carrying out any further checks is worthwhile. Even more important is that by doing so Friss supports an improvement cycle in order to translate the learning experiences into improvements in the quality of data, conditions, processes, purchasing contracts, etc. As well as this, Friss Settlement supports the normal control process.