Armor
Provider vetting program
Powered by revolutionary SPEARTM
Protect & save medical costs
Bill review integration w/EDI feed
Custom MPN scrubs
Lien defense
Our six-point program consists of protecting and reducing overall claims costs derived from a comprehensive and proactive SIU based strategy. Our extensive SIU experience drives our philosophical approach in delivering significant and sustained savings to our clients.
The recent enactments of SB 1160, AB 1244 and AB 1422 provided statutes to curtail medical billing fraud and abuse. The Department of Industrial Relations (DIR) actively lists well over 240 providers convicted and suspended. In addition, the DIR lists nearly another 900 providers who have been indicted or charged with a crime. For this, we have a solution.
Our ARMOR solution to these recent enactments is a Provider Vetting Program which is powered by our proprietary SPEARTM software system. This database has decades of compiled investigative research, material and data long before these new laws took into effect. SPEARTM proactively seeks to protect the medical claim portfolio of our clients through Bill Review integration, MPN vetting and lien defense. Utilizing unique identifiers, we can recognize non-qualified providers to include; suspensions, indictments, criminally charged, licensure issues, drug enforcement non-compliance, billing & coding violations, services rendered anomalies, prohibited referrals and other abusive or fraudulent practices.
Most importantly, SPEARTM will recognize suspended individuals and their controlling interests in other entities. Nowhere else will you be able to find all the corporations a suspended, indicted or criminally charged individual has financial interest in. Our research has identified thousands of additional corporations and Tax ID numbers associated with suspended individuals on the CA DIR list where a financial interest exists.
