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.
Using specialty software, analysis of existing, yet disparate, data banks can accomplish during an overnight batch run what an entire team of claim auditors cannot accomplish in a week: identification of every aberrant claim in the open and closed file inventories.