InvestiClaim

The McKesson Waste,

Fraud and Abuse
Management Solution
Healthcare spending in the United States
is projected to grow to $4.4 trillion, or to
over 20% of the gross domestic product
by 2018. Fraud and abuse alone account
for 3-10% of all medical costs, or as
much as $226 billion annuallya
figure that dwarfs credit card, identity
and insurance fraud. This unnecessary
spending is increasingly alarming to all
healthcare stakeholders.
Given the magnitude and visibility of the
problem along with the complexities of
the current payment system, payors are
being challenged as never before:

How do you ensure appropriate

management of aberrant claims?

How do you streamline investigative

processes?

InvestiClaim leverages
McKesson clinical expertise
built through more than
30 years of health plan
market leadership

InvestiClaim combines advanced clinical

content and statistical processes to
provide you with comprehensive,
efficient, highly cost-effective detection
and management of the most-suspect,
aberrant claims.

Benefits
Efficient workflowEnhances
efficiency with queuing, integrated
detection, workflow and case
management by focusing on
quality leads.

Comprehensive solutionCombines
clinical alerts, data analytics and
automated case management tools to
provide a comprehensive solution.

Enhanced preventionFlags and

denies suspected fraudulent or abusive
claims to save time and money.

How do you differentiate normal

clinical variations from inappropriate
claims?

How do you tackle suspect claims

Improved collaborationShares
information to build cases cooperatively
across your organization and with
outside entities.

quickly and systematically?

Minimal impact on your resources

The Solution
McKessons InvestiClaim waste, fraud
and abuse management solution
incorporates data-driven analytics to allow
you to rapidly identify, pursue and prevent
the most likely cases of fraud and abuse
known and unknown, including payment
policy aberrations. This automated,
integrated solution can be implemented
at any point in the payment lifecycle,

McKesson Health Solutions

from pre- to post-pay, to suit your

business strategies.

Increases your aberrance detection

capabilities without requiring significant new resources because its an
ASP solution.

Significant ROIRecovery of medical

spending per year estimated to range
from 5:1 to 22:1 for payors with fraud
and abuse solutions, based on statistics
from the National Health Care AntiFraud Association (NHCAA).

InvestiClaim
Increase productivity
Improve lead quality
Increase savings

Features
Data-driven analyticsAllows users
to identify familiar as well as completely
new problems at the provider, member
or claim level.

Clinical alertsPackaged sets of

clinical edits help identify specific
types of known and emerging billing
schemes. Clinically sophisticated alerts
provide additional layers of detection.

InvestiClaim web report view

Provides direct, on-line access to data
and reports without expert statistical
staff and minimal IT resources.

Integrated componentsDetection,
claim review reporting and case
management components are all
fully integrated.

Implementation optionsASP or
Electronic case management
toolsWorkflow tools consolidate
and manage evidential data and
investigation activities to build solid,
defensible cases.

customer-hosted, enables pre-pay or

post-pay detection.

Multiple Detection Points Optimize Your Payment Policies

As a modular component of McKesson Total Payment, InvestiClaim is able to leverage

its integrated code auditing and contract compliance capabilities so you can fully optimize
your medical payment policies.

FOR MORE INFORMATION

For more information on
InvestiClaim, contact your
account manager or call McKesson
at 800.782.1334
MHS@McKesson.com
www.McKesson.com

McKesson Total Payment delivers essential clinical, contract and fraud

intelligence to virtually every claims payment decision you make.