GETTING RESULTS. MAKING A DIFFERENCE.

Auditing services, namely, business, account, and cost report auditing for others; auditing of the operations and management of health care providers and managed care health plans; auditing of medical claims audit; asset auditing; business auditing; insurance claims auditing services; investigation services, namely, business investigation; providing statistical information for the statistical analysis of enrollment, special health status categories, and demographic information in managed care plans to determine inconsistencies, trends and vulnerabilities; auditing and monitoring of health care plans for compliance with regulations; auditing of Adjusted Community Rating used by managed health care plans; conducting marketing studies in the nature of probe studies of enrollment and eligibility data for managed care health plans; health care cost review in the nature of cost, utilization and review services to the health care industry; review and audit managed care enrollment and eligibility information to ensure that individuals are properly and timely enrolled; marketing consulting in the nature of review of marketing materials and quality of care for managed care health plans

Insurance consultation services in the nature of claims appeals services, providing reviews and expedited reviews of denied health care claims for health care programs, providing review and analysis of denied claims to determine inconsistencies, trends, and vulnerabilities and coordination of subsequent appeals; financial services, namely, financial research

Review of standards and practices to assure compliance with implementation of changes in managed care enrollment, special health status categories, and demographic information for state and county codes; review of standards and practices of others to assure compliance with Federal laws and regulations in the health care industry

Health care consulting services in the nature of review of medical records

Investigation services related to insurance claims; investigation services to detect, prevent, and aid in the prosecution of fraud and abuse in both the public and private sector of the health care industry; fraud detection services in the nature of utilization review services, and programs and services to detect, prevent and aid in the prosecution of fraud and abuse in the public and private sector of the health care industry