Background

Founded in 2003, MicroVu has created the most thorough data management, mining and health care claims audit process in the industry. We have leveraged both organic and acquired technology, along with superior industry intelligence, to recover millions for public and private sector clients across all industries nationwide. Our clients range in size from a few thousand to millions of covered lives.

Our Concept

MicroVu specializes in 2 distinct, but equally important methods of payment integrity; Data Science and Data Mining. MicroVu delivers customized, flexible and unrivaled performance to our clients. We are pleased to share our capabilities to introduce Data Science as our newest and most innovative overpayment identification tool.

Through data science, MicroVu is able review claims data from a uniquely different perspective, uncovering statistical significant outliers and patterns that are routinely missed through traditional algorithms. MicroVu’s auditors, technology specialists and scientists investigate these patterns to uncover overpayments, fraud and overspending that would otherwise go undetected. We truly take a “forest from the trees” approach and apply an arial view to the identification of recoveries.

Audit and Recovery Process

MicroVu’s Data Mining team analyzes the clients paid claims, typically mining 24 – 36 months of data. The typical commercial health plan acknowledges that 2%-3% of all insurance payments are made in error. MicroVu’s data mining expertise assists any size health plan in recovering overpaid funds quickly, efficiently and cooperatively. MicroVu uses sophisticated technology and algorithms, which are customized to the plan/client policies and guidelines, allowing the electronic detection of improperly paid claims.

MicroVu uses claim experts such as certified coders and clinicians to validate every claim; we do not base our results on extrapolation methodology. We deal only with the “confirmed & validated” overpayments, which greatly minimizes any provider or network disruption. MicroVu ensures quality control measures are made to achieve 85%-90% hit rate by claim in submitted overpayments to clients. Once validated by experienced analysts, overpayments are ready for recovery. MicroVu uses an enterprise system which houses all client’s results, performance and reporting. This system tracks the auditing process through the entire life cycle, from identification to recovery. Based on a plan’s specific requirements and needs, various methods are deployed for submissions and recovery processes.

REVIEW   RECOVER   REFUND   RESULTS

 

Contact Us

We look forward to sharing more about our cost containment and
recovery solutions. Please contact us to learn more about how
MicroVu can recover lost funds for your health plan.



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MicroVu, Inc.

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