Heres a coolness problem. Working at a HMO and going through the claims tables you slowly discover that
on a regular basis there are different claim numbers that have tell tale fields in common namely the service date
field is the same , the member number is alike and the diagnosis code matches on 2 or more different claim numbers.
After researching these claims it shows these signs inevitably mean more than one claim is being issued for the
same visit. No NO no should'nt do that!
How do you set this out in a usable output ie. I suppose the 1st best thing is to get rid of the good legitamate non
"duplicate" claims and leave the suspect claims. The word "duplicate" is actually refering to the telltale symptoms
of same diag, date and client name, not the actual claim numbers which are different.
I havn't come up with anything other than sorting them out so they are easier to stare at and detect.

DOWN WITH CLAIMS FRAUD --- YOU CAN MAKE A DIFFERENCE!!

Swimming in free handouts at St. Louis...........Joe Mc.