1. APU … IT’S FOUND MONEY!
Mining Claims Data;
Recovering Claims Overpayments
Data Mining & Overpayment Recovery

2. THE SCOPE OF FINANCIAL LEAKAGE:
Claim payment systems and
workflows leak between 1-3% of
total paid annually
Customized Data Mining & Overpayment Recovery

3. Typical Payment Approach
• Prospective
• Algorithmic in nature
• Ad hoc, claim-by-claim basis
• Uses underdeveloped claims systems
• Limited plan/payment logic
• Human-based process
Customized Data Mining & Overpayment Recovery

4. Sources of Leakage
• Personnel changes
• Data entry errors
• Multiple billings/inconsistent cycles
• Peripheral data errors (vendor, policy,
enrollment, check writing)
• Manual overrides
• Manual checks
• Inconsistent connections between peripheral
data sources
Customized Data Mining & Overpayment Recovery

5. Traditional Countermeasures
• Random file reviews
• Paper audits
• Supervisory controls
• Case management
• Manual processes that are inefficient and
summary in nature
Customized Data Mining & Overpayment Recovery

6. The APU Solution: MINE DATA
• Collaborate with client to identify errors
• Construct client specific analytics that review
ALL claims
• Don’t AUDIT claims data; MINE claims data
• Articulate claim, policy, provider, and payment
data in a “mine-able” format
• Analyze at the transaction level
• Think retrospectively, not prospectively
Customized Data Mining & Overpayment Recovery

7. The APU Process:
RECOVER OVERPAYMENTS
• Use existing client data extracts
• Automate production and delivery of inquiry
letters
• Follow up and resolve overpayment requests
• Handle all inquiries
• Receive and account for reimbursements
• Provide full accounting and a CHECK to client
Customized Data Mining & Overpayment Recovery

8. The Benefits
• Recover 1-3% of total dollars paid
• Cleaner data
• Fundamental system errors identified
• Improved payment processing
• Outsourced solution frees up internal
resources
Customized Data Mining & Overpayment Recovery

9. The APU Value Proposition
• No start up costs
• Risk free: We work on a contingency basis; we
only get paid when we recover your money
• Little effort: Client involvement is kept to a
bare minimum
Customized Data Mining & Overpayment Recovery

10. The Result
“APU … IT’S FOUND MONEY!”
- Brad J., Dental Insurance Executive
Customized Data Mining & Overpayment Recovery

11. FOR MORE INFORMATION,
PLEASE CONTACT
JIM DEL VECCHIO,
PRESIDENT & CEO
Phone: (866) 434-8303
Fax: (806) 378-9822
Email: jdelvecchio@apuinc.com
Customized Data Mining & Overpayment Recovery