Thomson Reuters uses its decision support applications and advanced data investigation methods to detect and investigate healthcare fraud, abuse, and waste.
Benefits
Thomson Reuters has helped numerous organizations use data from health claims and other sources to produce actionable information. Our customers have used Thomson Reuters systems and analytical consulting to:
- Profile providers and patients
- Identify and prevent payment problems
- Recover misspent funds
- Improve the quality of healthcare
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Advantage Suite - Government
Medicaid agencies that can quickly access and analyze their program’s healthcare data are better positioned to address challenges and provide high quality care to beneficiaries.
Advantage Suite® integrates information from diverse sources and systems, organizes it to support decision making, and enables easy access to information in a flexible, customized application. Its powerful applications are linked to an integrated warehouse of medical and prescription claims, encounters, eligibility, lab results, authorizations, health risks assessments, and performance measures. -
Consulting Services - Government
The Healthcare business of Thomson Reuters has proven consulting resources and experience to help government agencies balance the cost and quality of healthcare within the constraints of the fiscal environment. Our experience with more than 25 states and multiple federal agencies enables us to provide unique insights for addressing specific program needs. Our benchmarks help agencies better identify opportunities for program redesign and improvement, while our proven clinical and analytic methods ensure the information is reliable.
Thomson Reuters delivers a combination of flexible and powerful analytics with embedded methods that enable fast retrieval of data. Our consulting studies are independent of Medicaid Management Information System staff, ensuring rigorous and impartial review of program performance. -
J-SURS™ Fraud and Abuse Detection System
Healthcare payers must be able to detect and deter those few providers and beneficiaries who attempt to abuse or defraud their systems. While the individuals are few in number, the losses are substantial, and they affect both the bottom line and ultimately the quality of care. J-SURS from Thomson Reuters gives you a powerful and user-friendly stand-alone solution for fighting healthcare fraud and abuse. J-SURS not only integrates easily into your existing environment; it also provides easy, effective review and analysis of claims data to all users – from data specialists to medical professionals.
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Medical Episode Grouper - Government
The Medical Episode Grouper® (MEG), from the Healthcare business of Thomson Reuters, enables government agencies to analyze patient treatments, evaluate quality of care, and manage associated costs. It does so by grouping inpatient, outpatient, and pharmaceutical claims into clinically homogeneous units of analysis called episodes that describe a patient’s complete course of care for a single illness or condition. The result is a sophisticated methodology that is used for a wide range of applications such as provider profiling, disease management, quality improvement, and cost and use analysis. Agencies can incorporate MEG into their existing information system, or it can serve as an integrated component of Advantage Suite®.