Verisk Health
Effective Solutions to Reduce Healthcare risks and Enhance Service Quality

With nearly two decades of experience in clinical informatics and healthcare IT, Nadine Hays has brought in a wealth of expertise to healthcare industry. Her understanding of an efficient healthcare system and its requirements across payers, providers and employers paved way for the conception of Verisk Health. The Massachusetts-based firm, Verisk Health focuses on transforming businesses within the healthcare arena by providing data services, analytics and advanced technologies to control the most complex industry imminent challenges. “We provide scientific, medical and clinical support to optimize their performance for greater business efficiency,” says Nadine Hays, President, Verisk Health.

Verisk Health is committed towards helping healthcare plans, employers, and other risk bearing entities improve the services quality, reduce cost, ensure appropriate revenue, and support compliance. “By collecting and leveraging disparate data sources, and applying our analytics expertise, we’ve created new ways to resolve the toughest business decisions in an organization to successfully impact both the quality and cost of care,” says Hays. The analytics and human expertise of Verisk Health provides a customized SaaS platform that helps meet customers’ business needs and minimize their IT burden.
The need for healthcare software solution rises with the growing problems such as administrative waste, system inefficiencies, billing errors and excessive expense in the health sector. Verisk Health’s Claim Accuracy solution provides accurate pay and reviews the most complex and expensive inpatients claims. “Our Claim Accuracy solution extends far beyond claim editing to comprehensively address errors, waste, and abuse,” says Hays. In addition, their data-driven solution delivers health plans, providers, and employers for measuring and benchmarking the overall performance for their clients. “We evaluate programs and vendors by evaluating costs, utilization and compliance trends to ensure that the resources spent effectively,” says Hays.

The firm’s recently launched innovative Accountable Care Organization (ACO) solution provides quality reporting for the Medicare Shared Savings Program (MSSP) and supports population health management through advanced risk analytics and workflow tools. Furthermore, the offerings helps track yearly data analysis and reduces waste, measures practice variation, and facilitates ACO measured reporting and submission.

Our Claim Accuracy solution extends far beyond claim editing to comprehensively address errors, waste, and abuse

Additionally, the healthcare solution provider identifies various billing behaviors, coding rule violations, and aberrant billing patterns with its Fraud Detection solution. This solution delivers detection analytics, predictive modeling, case tracking, and special investigations unit (SIU) services, providing broad protection from Federal wide Assurance (FWA). “Alongside the functionalities of our solution offering, the Revenue Answers of Verisk Health provides integration and management of all critical risk adjustment activities from reconciliation and discrepancy management and chart review services,” explains Hays. Verisk Health’s Population Answers solution interprets and manages population healthcare risks. “This solution suite enables users to provide efficiency and inform improved risk contract partnerships between payers and providers,” adds Hays. Additionally, the Quality Answers solution provides technology to track and monitor efficiency, identify noncompliance and implementing engagement strategies that lead the way for a successful business.

For the future, the company plans to focus on improving the patient experience and maintaining business stability and profitability by delivering technology to address critical business challenges of customers. “We wish to take forward our decades of experience in adding value to clients and unravel ways to improve service quality and revenue generation,” concludes Hays.