Program Integrity
Preventing fraud involves a balance of carrying out the core responsibility to protect the beneficiary’s access to necessary health care services while reducing the administrative burden on legitimate providers and suppliers. The program integrity effort requires businesses, federal agencies, states, and contractors to operate as an integrated team. To support the collaboration among multiple stakeholders requires the right level of data/information and collaboration tools at each step in the process. eSimplicity’s SMEs and engineers know and understand every touch point in the process, including provider credentialing and enrollment; advanced fraud, waste and abuse model development (with minimal false-positive findings); collaboration or case management workflow; self-service analytics and visualization; and the data access capabilities. At eSimplicity, the stakeholder business operation drives the technology implementation. We ensure people have the right access to the right data/information at the right time.