Protect your organization by monitoring the providers who deliver care.
Are providers delivering the services they report? Do they have outstanding claims issues? Is there a facility where they say it is? And does it have the right equipment for beneficiaries?
Our subject matter experts know all the scams and schemes, so they can stay steps ahead of bad actors and fraudulent activity. Our data scientists monitor and analyze provider enrollment databases, searching for enrollment risk factors, investigation data, medical review findings and more — to determine low, moderate and high-risk providers.
Our team makes on-site visits — scheduled, unscheduled and unannounced — to observe that your beneficiaries receive treatment in appropriately equipped and staffed facilities and ensure that only legitimate businesses are enrolled as providers.
Through our Audit Medicaid Integrity Contractors work, Qlarant has worked with 34 states and the District of Columbia to find overpayments and decrease the payment of inappropriate claims. Our auditors, investigators, medical claims reviewers, and data analysts review and analyze claims submitted by all types of Medicaid providers — to identify aberrant claims and potential billing vulnerabilities.
Other services include monitoring provider enrollment and competitive bidding programs, maintaining key contacts, and verifying licensure of providers, both in and out of state.
Let us help protect your resources and the people you serve. Talk to Qlarant experts about enrollment monitoring and analysis.