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IFM 4.0 Reporting Framework

FICO® Insurance Fraud Manager User Group :. San Diego, CA | May 7--8, 2014 . IFM 4.0 Reporting Framework. Allyn Pon Senior Product Manager, IFM FICO. IFM Reporting Tree Today. Pharmacy. Management. Dental. Medical. Our Challenge.

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IFM 4.0 Reporting Framework

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  1. FICO® Insurance Fraud Manager User Group: San Diego, CA | May 7--8, 2014 IFM 4.0 Reporting Framework Allyn Pon Senior Product Manager, IFMFICO

  2. IFM Reporting Tree Today Pharmacy Management Dental Medical

  3. Our Challenge • How to make it easier for users to understand which reports are available • How to make it easier for users to find the right report • How to replicate 600+ reports without rewriting every single one • Provide a foundation for developing new reports that is easier • Complete this effort within a major development cycle

  4. IFM Data Visualization and Reporting

  5. IFM Today • IFM has over 600+ reason code “reports” • Most reason code reports compare suspect provider to peers • Business Objects generate both data visualizations and reports • For IFM 4.0, Significantly enhanced usability of data visualizations and workflow for reporting, based on a new FICO reporting framework Business Objects Oracle

  6. 4.0 Discussions – Report Types • Today • Top 10 (Bar Chart) • Comparison Charts (Clustered Column Charts) • Distribution Charts (Line + Bar Chart) Comparison Charts Proposed Current

  7. New FICO Reporting Framework • New FICO Reporting Framework is based on metadata • Metadata summarizes basic information about data, which can make finding and working with particular instances of data easier. For example, author, datecreated and date modified and file size are examples of very basic document metadata.

  8. Benefits to New FICO Reporting Framework • Faster Response Times • More control over data visualization output • More visually pleasing • Flexibility to place derived visualizations/reports at various locations within the application • Improved Ease of use - Less clutter

  9. Reports in IFM Today Will Still Be in IFM 4.0 Provider Summary (Rendering & Billing) Reason Codes Member Summary Management • Financial Breakdown • % of Dollars/Month • Member Breakdown • Claim Lines by Age & Gender • Procedure Breakdown • % Dollars by Procedure Grp • % Dollars by Diagnosis • Time Breakdown • $ Per Drug Grp • Diagnosis Breakdown • Top Days (By $, Procedures, • Procedure Grp Mix • Diagnosis Grp Mix • TOS & POS Grp Mix • Age/Gender Mix • Member Consecutive Visits • Per Day Activity • Per Member Volume • Procedure Grp Activity (Dollars) • Procedure Grp Activity (Top 10 % of Claim Lines) • Inventory • Claims by Queue • Claims by User • Claims by Status • User Deny Claim Cases • Claim Line Cases • Case Management • Case Data • Recoveries • Costs • Family Affiliations • Financial Breakdown • % Claim Lines/Procedure • % Dollars/Procedure • % Claim Lines/Diagnosis Grp • % Dollars/Diagnosis Grp • Top 5 Days by Dollars • Top 5 Providers By Drug • Top 5 Procedures By Dollars • Top 5 Drug Groups by Dollars • Procedure Summary

  10. IFM 4.0IFM Reporting vs Visual Insight Studio • IFM Reporting Framework and Visual Insight Studio are two different functions and capabilties • IFM Reporting Framework is custom developed to meet our visualization and reporting needs • IFM Reporting Framework is included within the IFM application • Visual Insight Studio is a separate add-on license for hosted customers

  11. IFM 4.0Data Visualizations and Reports • Data Visualizations (Reason Code Reports) will be moved to the Provider Summary module under the Analytics subtab • Management Reports will remain and launched from a Reporting Tab • Will deliver all management and inventory reports currently available in IFM • Need your help to filter out which reports are important or need to be changed • Data for the new reports will be sourced either from Oracle or from MongoDB, depending on the nature of the report and the required response • Oracle tables remain as the single point of truth

  12. FICO® Insurance Fraud Manager User Group: San Diego, CA | May 7--8, 2014 Thank You Allyn Pon(858) 369-8487allynpon@fico.com

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