GEHA selects FICO analytic solution to detect FWA health claims

Government Employees Health Association (GEHA) has selected FICO Insurance analytic solution, FICO Insurance Fraud Manager, to intensify fight against insurance fraud, waste and abuse (FWA).

FICO Insurance Fraud Manager, combined with FICO Blaze Advisor business rules management systems provides more broadly and effectively detect and prevent insurance FWA and deliver savings and efficiencies for GEHA.

The FICO solution, FICO Insurance Fraud Manager will monitor and manage GEHA’s pharmacy and dental claims by detecting fraud, abuse and errors and identifies suspicious providers as soon as aberrant behaviour patterns emerge.

With this solution, providers can accelerate claims processing by avoiding improper payments, increasing loss recovery and correcting systemic vulnerabilities while saving money.

The simple administration and intelligent tools of the system enables low total cost of ownership yet high return on investment that streamline review and investigation of suspicious claims.

FICO Blaze Advisor business rules management systems provides greater efficiency and results by proactively evaluating claims and stop known fraud earlier in the process.