Peer Science consultants are experts in the design and development of comprehensive, web-enabled systems for medical insurance billing compliance, especially in Medicaid. Our complete solution is implemented in three powerful components.

Sentinel Case Management^TM
Effective case management is an essential component in a healthcare compliance system. Sentinel Case Management transforms the supervisor and investigator experience by providing powerful simple-to-use tools. Early warning of non-compliant behavior and a familiar web interface allow the supervisor to rapidly assign cases to investigators. An estimate of predicted revenue returns enables the most efficient allocation of investigative resources. Investigative tools allow investigators to act in timely manner.

• Supervisors may search for similar behaviors. Some investigations will reveal noncompliant behavior that is particularly worrisome or exceptional. An example of patient abuse, for example, may be discovered and cause concern that other instances may also exist. In this event, the supervisor can examining the case can simply press "More Like This". This simple action will cause the database to be searched for providers with similar behavior patterns and return a list to the supervisor ranked by similarity to the example case.
• Investigators are provided "clues". When a case is assigned, the investigator needs more than just a provider or recipient number to give the case a good start. Sentinel Case Management provides the investigator a set of clues derived from the analytics and drawn from similar past cases. This "jump-start" facilitates the rapid resolution of cases for timely recovery.
• Learns from experience. As each case is resolved, the results of the case are stored in a special database. This "case-base" acts as a repository for "experience" that is accessed to provide clues for future cases. In this way, the case management system continuously improves its performance, providing an expert guide for new investigators and useful hints for seasoned veterans.

Sentinel Reports^TM
Users expect a well-designed intuitive interface.

• Familiar Web interface. Using the interface which is most familiar to computer users limits the training required to become proficient. Since the client interface is a web browser, no client software updates are required.
• Comprehensive Security. Peer Science recognizes the importance of protecting medical billing records and investigative information from unauthorized access. Sentinel Reports effectively restricts access to authorized users, and that access is further limited according to restrictions set by the supervisor. For example, access to information on a particular case is limited by default to the case supervisor and the investigator the supervisor assigns to the case.
• Designed by users, for users. Report screens were designed with constant evaluation and feedback from actual supervisors and investigators. This means you will be presented with exactly the information you need in the way you prefer to see it.

Sentinel Core Analytics^TM
Detection of billing anomalies is a complex problem requiring sophisticated tools and the skills to use them. The Peer Science team has been the leader in advanced analytics for billing compliance for years. Others offer single-technology solutions that give weak partial solutions. Since Peer Science expertise extends across multiple technologies, we are uniquely equipped to provide a robust comprehensive solution to all aspects of billing compliance monitoring.

• Unique pattern matching. Peer Science's Proprietary eXtreme Search technology enables soft matching on heterogeneous patterns. While other systems are restricted to matching text or numerical vectors, we have gone beyond the state of the art to match on virtually any type of data encountered in the healthcare environment.
• Advanced fuzzy technology. One component of our multi-faceted approach to compliance monitoring is a fuzzy expert system for detecting billing anomalies. This advanced, yet simple-to-use system allows investigators to write their own rules for probing billing behavior.
• Comprehensive algorithm suite. Some types of non-compliant behavior are too complex to be captured in a simple rule. Sentinel Core Analystics provides a suite of algorithms for detecting specific types of complex non-compliant billing behavior.
• Behavior profiling. Our behavior profiling system captures critical characteristics of provider billing behavior. Besides enabling our built-in detection of billing anomalies, these profile characteristics are available to the investigator for probing provider behavior trends and for inclusion in fuzzy rules.