2015 Annual Training Conference & Anti-Fraud Expo

Sessions Speakers Exhibitors Show Specials Floor Plan Buzz

Pharmacy Claims Advanced Data Analytics (Room Seaport A)

Specialty drug spending saw a record increase in 2014. Advanced analytics can reduce costs for PBMs and Health Plans alike. Topics of discussion will include: member drug seeking behavior identification - can be due to addiction or drug diversion and collusion - for every $1 of abused drugs, an additional $50 is wasted on related medical claims; J code to NDC comparison to identify potential overlap in payment under both the pharmacy and medical benefit; compound analysis representing a disproportionate amount of fraudulent claims, trends and billing spikes can be identified early, pharmacy report cards and fraud dashboards.