Public Health Program Integrity

Enformion’s program integrity services provide secure batch file processing services for claims audit purposes.

Dual Participation

Beneficiaries that are financially struggling may relocate in search of better opportunities. In that process they may also, unsurprisingly, apply for additional benefits in their new state of residence. The resulting dual participation creates an undue burden to taxpayers – whether the duplication is innocently unintentional, or a fraudulent effort to obtain additional benefits.

Enformion’s research application and automated batch processing capability provide a Day One/turnkey solution for health agency leadership to quickly mitigate this growing problem.

Ineligible and Deceased Beneficiary Audits

Enformion provides automated batch processing of beneficiary rosters, appending date and place of death, and evidence of ineligibility – such as residing in another state to output files customer pickup and processing.

Increasing Internal and External Efficiency

Efficiency is one of the most important components of creating a department focused on health program integrity. You want to make sure you’re not wasting resources while discerning if a health care provider is wasting resources. If you use Enformion’s tools to look into places where there could be cause for concern, you can do your job more easily.

• Every piece of the puzzle helps you increase your efficiency from top to bottom.
• When you utilize the best technology and stay on the cutting edge of development, it can boost you and your department to the forefront.
• Enformion has over 30 years of experience in the industry and keeps its sights set on innovation and expertise.

Understanding the People You’re Serving

If you’re going to understand potential fraud in the system, it’s important that you know more about the people receiving care under it as well. What looks like fraud to you may just be the result of someone with a rare or difficult-to-treat disease finding a doctor who knows about that disease. Enformion will help you understand more about the people in the system, so you can understand the system itself.

• Just knowing the numbers isn’t enough; it’s essential that you also get to know the people behind the numbers.
• You can use Know Your Customer resources, which businesses typically use to enhance their services, to understand the people you work with.
• Although you might think of these resources as being only for the private sector, Enformion can help you use them for the public sector as well.

Creating Options Tailored to Your Needs

Your department isn’t going to have the same needs as other departments, even if they perform tasks similar to yours. You know what’s best for your department and what doesn’t work. Even the same exact department in another state likely won’t work the same as yours. Enformion gives you a way to create solutions based around what you’ve already established.

• You need to tailor your options to your needs, which means you need a customizable platform.
• Even if you don’t know what you need right now, a Data Solution Expert for the government can help you learn more.
• Different government contract options at Enformion will provide you with the information you need to do your job in the most efficient way possible.

Performing Manual Investigations More Easily

When you’re working with health program integrity, you’re going to perform manual investigations. Most of your job will probably be about determining when it’s time to perform a manual investigation, then trying to get through that investigation. That’s why it’s so important to increase your efficiency with Enformion every time an investigation is necessary.

• Though Enformion provides a number of tools to automate parts of your work, its helpfulness doesn’t end there.
• It can also make it easier for you to perform the manual investigations you need to complete.
• The Enformion search platform allows you to get information you can use to perform your manual investigations without having to search for it alone.

Reducing Busywork for a Better Program

It can be difficult to make sure everyone’s utilizing health services appropriately and fully. Health program integrity ensures that everyone gets a fair chance with health services by reducing fraud from providers and patients. As a department that enforces health program integrity, you have an incredibly important job, and you need Enformion’s tools to help you do it.

• Busywork cuts into your ability to offer high-quality health services to as many people as possible.
• When you can enforce health program integrity through a variety of tools and options, you’ll be able to offer more to the people you serve.
• Regardless of what type of information you need to get about individuals, you can use Enformion to help find it.

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