MST
MEDICAL SEARCH TECHNOLOGIES
CFO DASHBOARD: FWA Medical Insurance Analytics
Prior Authorization (PA)
Special Investigations (SIU)
Utilization Management (UM)
PA ANOMALY ANALYSIS BY SERVICE CATEGORY
Total Dollars Involved
Anomaly Dollars Under Scrutiny
Anomaly Dollars Under Scrutiny
Total PA $:
$215M
Anomaly PA $:
$34M
(15.8%)
# PA Cases:
145K
SIU ANOMALY ANALYSIS BY SERVICE CATEGORY
Total Dollars Involved
Anomaly Bill 4 Cases
Anomaly Bill 4 Cases
SIU Investigated $:
$89M
Anomaly SIU $:
$21M
(23.6%)
# Open Cases:
4,200
UM ANOMALY ANALYSIS BY SERVICE CATEGORY
Total Dollars Involved
Anomaly Dollars Under Scrutiny
Anomaly Dollars Under Scrutiny
UM Total $:
$470M
Anomaly UM $:
$56M
(11.9%)
# Outlier Cases:
22K
ANOMALOUS SERVICE CATEGORIES (Ranked by Anomaly $)
| Category Name | Total Claims | Anomalous Claims (Count) | Total Providers | Total Anomalous Providers | Total Dollars Involved | Anomaly $ Amount % |
|---|---|---|---|---|---|---|
| Pain Management | 21,500 | 6,020 | 315 | 88 | $5,250,000 | 28.0% |
| Physical Therapy | 33,600 | 8,400 | 460 | 125 | $4,200,000 | 25.0% |
| Imaging | 18,200 | 2,730 | 260 | 42 | $4,800,000 | 15.0% |
| Orthopedics | 25,100 | 4,518 | 370 | 70 | $3,500,000 | 18.0% |
| Laboratory Services | 28,000 | 3,500 | 410 | 60 | $2,800,000 | 12.5% |
| Behavioral Health | 14,300 | 1,716 | 210 | 28 | $1,900,000 | 12.0% |
| Emergency Dept | 19,000 | 1,520 | 290 | 28 | $1,100,000 | 8.0% |
ACTION ITEMS
| Task | Department | Assigned To | Due Date |
|---|---|---|---|
| Review CPT 27447 anomalies for SIU | SIU | Jane D. | 05/01/2023 |
| Investigate PA spike for Advanced imaging | PA Ops | Mike R. | 05/01/2023 |
| Analyze high risk UM cases for Q3 | UM Team | Sarah P. | 03/01/2023 |
| Review CPT 27447 anomalies for SIU | UM Team | Sarah P. | 03/01/2023 |
| Investigate PA anomalies for Advanced imaging | PA Team | Chris B. | 03/20/2023 |
ANOMALY DOLLAR TREND OVER TIME (Last 6 Months)
$ Anomalies
Total $ Processed
Total $ Processed