DBQuest Inc. has experience in analyzing claims data as well as applying analysis on key nodes such as members, providers, procedures to identify claims with high risk for fraud. Additionally we can also analyze claims with potential waste or abuse such as clinically unnecessary spending.
DBQuest Inc. has been involved in reporting on alternative payment models including global payments, Patient Centered Medical Homes (PCMHI), bundled payments, and episode based payments. These involve analyzing claims on several attribute based (DOS, member, provider) groupings as well as clinical (procedure, diagnosis) based groupings.
DBQuest Inc. understands the complexities of analyzing health care claims data which often involves lag, claims adjustments and revisions, prior authorizations and pre-admission screenings, diagnosis and diagnosis groupings and reference data on procedure codes, modifiers, NDC codes. DBQuest Inc. has helped clients upgrade from HIPAA 4010 to 5010, and ICD-9 to ICD 10 standards. DBQuest has understanding of public payer (Medicaid) systems.
DBQuest Inc. specializes in all aspects of health care administrative data starting from eligibility, enrollment, and benefits plans for members, including managed care, health care claims data, provider enrollment and member assignments to Providers.