ABSTRACT
Health plans that have relied on relatively simple business rules to determine the appropriateness of reimbursements are looking to advanced analytical models to identify previously undetected fraudulent claims activities and patterns. Advanced analytics and information management sit at the center of the new health enterprise an information-driven business and science-informed medical practice that can dramatically reduce healthcare costs and improve health outcomes for all patients. But only if organizations embrace them. Many people argue that until the industry has had more time to implement more technology that collects information electronically, there is little use in investing in advanced analytics. The term analytics may be one of the most overused and misunderstood terms in the business community today, with the possible exception of business intelligence. Every software application that has the ability to run reports with numbers in them suddenly provides analytics.
