Health Insurers

Write Stephens Technology Group The Information Architecture ExpertsStephens Technology Group provides integrated data management to the health insurer industry with services that include: which holiday is tomorrow

  • Fraud detection - Searching for claims where the service has not actually been provided. Looking for patterns that would suggest further inquiry into the claim.
  • Abuse detection - Searching for patterns indicating that certain providers are performing unnecessary procedures, prescribing expensive medication where a less expensive drug would be as effective, performing unnecessary tests and keeping a patient in the hospital longer than necessary.

Blue Cross

  • Analysis of claims
  • Providers analysis
  • Reporting to groups, government agencies, trade associations
  • Analysis of quality of care and costs
  • Marketing managed-care contracts
  • Financial analysis (actual expenses vs. planned expenses)
  • Profitability of manager care arrangements
  • Contract performance
  • Fraud analysis based on the provider’s health care specialty and the geography of the claim

Pharmaceutical Insurance

  • Sales and marketing
  • Provider profiling
  • Government reporting
  • Utilization
  • Claims
  • Actuarial
  • Integrating pharmaceutical information with medical claims
  • Cost analysis by patient demographics and geographical distribution
  • Cost analysis by provider, provider specialties and treatment protocols
  • Analysis by diagnosis/prescription
  • Generic/brand name drug comparisons

Insurance Research

  • Claims information