Aberrant Claim

A medical claim submitted by a physician or other health care provider for reimbursement from third-party payers, that may be financially abusive or fraudulent
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This report identifies aberrant claim files with unusually high loss adjustment expense and also helps establish a targeted value of desired average loss adjustment expense by LOB and peril.
Highmark also reduced the time necessary to identify fraudulent claims by comparing aberrant claims data with that of peers, reducing the number of post-payment fraud investigations and the cost to dispute them.
Our claims staff repeatedly acknowledged that Payment Optimizer helped to identify aberrant claims that would have otherwise gone undetected," said Greene.