HDMGS’ proven and proprietary data analytics helps government agencies reduce health care expenses and improve program efficiencies — resulting in the identification of control issues, potential fraud, overcharges, and future savings. Our data analytics and reporting are used to support audit programs, fraud investigations and program integrity initiatives.

We customize our proprietary technology with claims data, plan procedures, and contract provisions in order to provide an efficient and detailed assessment of program administration and to assure financial accuracy and proper delivery of benefits.

Data Warehouse
Our proprietary data warehouse is scalable and integrates multiple data sources into a single source, including; encounters, medical claims, pharmacy claims, benefits data, and eligibility data. It begins with a historical data set and then offers continuous research and benchmarking using the expanded claims data warehouse from timely data imports.

Business Rules Engine
Our business rules engine consists of customized rules modeling the program’s plan design, contract provisions, covered services, maximums, exclusions and eligibility rules. The underlying algorithms have been developed utilizing industry best practices and standards, and fraud and abuse guidelines. The business rules will be executed against 100% of claims and eligibility data in the warehouse.

Benchmarks
Benchmark data is established from all public and industry sources including results from extensive audits we have conducted for our public and private sector clients.