2017 Preliminary Agenda

Thursday, October 26, 2017

Breakfast and Registration


Opening Remarks by Conference Chairperson


Keeping Pace with the Fraudsters: Examining the Latest Trends in Claims Fraud & Best Practices to Mitigate Fraud Risks

  • Insights on what the government looks for in claims fraud
  • Discuss focus areas that plans should be looking at to eliminate
  • Tip for a robust approach to mitigate claims fraud
  • Outline the step that you should take when you find something suspicious
    • Who to report to
    • What your obligation are to report your findings

Kirstin Ives, Partner, Falkenberg Fieweger & Ives LLP


Developing Analytical Capabilities to Drive Claims Auto-Adjudication

  • Hallmarks of effective auto-adjudication analytics
  • Integrating seamlessly into existing systems
  • Creating effective feedback loops
  • Reporting structures that promote quick response monitoring and action

Raul Matas,Director of Strategy,California Claims Operation, Kaiser Permanente


Networking Refreshment Break


Overcoming Obstacles to Work Together as Payers and Providers to Improve Claims Payment Accuracy

  • Discuss the role trust between payer/provider plays in claims accuracy
  • Discuss how to insert the integrity step between the time of claims submission and claims payment
  • How can plans help provider to submit "clean" claims
  • Effective Strategies to Optimize Payer/Provider Communications
  • Discuss the key challenges and issues health plans & providers face when communicating with each other and
  • st practices to improve communication

Brian Witherow, Product Operation Clover Health Plan

Heather Cozzens, Claims Manager Clover Health Plan


Improving Claims Processes Through Streamlined Benefits Coordination

  • Examine the costs associated with inefficient coordination of benefits (COB) processes../li>
  • Review pain points for providers and payers related to COB processes.
  • Suggest criteria and identify specific options for navigating COB challenges.
  • Discuss the impact of streamlined COB processes.

Sherry L. Murray, Director, EnterpriseCoordination of Benefits Department, Anthem


Using AI to Improve Claims Processing

Did you know that artificial intelligence (AI) is ready to make your healthcare claims processes smarter? Did you know it can be a seamless part of healthcare claims automation? Learn how AI can help you "go digital" in just a few easy steps. See examples of how real companies are using AI to drive claims adjudication and automate data extraction, streamlining their efforts and improving the accuracy of claims processing.

You'll walk away knowing how to:

  • Switch from paper-based to automated processes quickly and easily
  • Setup your claims processes to leverage today's AI offerings
  • Reduce the time and cost per claim, saving your organization money

Christina Robbins, Marketing Manager, Digitech Systems, LLC


Networking Lunch


Key Insights to Leverage Payer/Vendor Partnerships to Reduce Claims and Administrative Costs

  • Structuring effective payer-vendor partnerships
  • How to incorporate win-win benefits for both sides
  • Understanding the real pain points and cost/benefit drivers
  • Developing enduring solutions

Morgan Tackette, Senior Product Director,Council for Affordable Quality Healthcare (CAQH)

Sherry L. Murray, Director,Enterprise Coordination of Benefits Department, Anthem


Utilizing Data Analytics and Predictive Modeling to Improve Your Overall Claim Management Strategy

With the continued rise of information technology and data science, insurance carriers are assessing ways to securely leverage their claims data for purposes of analysis and predictive modeling. Whether through strategic partnerships with external vendors, internal model development, or a combination of both, companies are continuing to evaluate and pursue utilization of these cutting edge tools.

  • Hear the strengths, weaknesses, and opportunities associated with using data analytics and predictive modeling as part of your overall claim management strategy.
  • Hear how using big data analytics can help to improve claims processing

Thomas Everett, Senior Director, Claims Audit, Health Plan


Networking Break


Link Analysis and Predictive Analytics - The Perfect Marriage in Claims Fraud Prevention

Predictive analytics can deliver significant savings for healthcare payers. Insurers deploying analytics as part of their anti-fraud efforts have seen reductions in fraudulent claim losses of 20 to 50 percent and loss adjustment expenses of 20 to 25 percent

Learn how to:

  • Use predictive analytics and link to detect fraud
  • Prioritize claims by likelihood of fraud
  • Reduce false positives by more accurately identifying real fraud
  • Mitigate fraud and improve customer satisfaction by streamlining the payment of legitimate claims

Jason DiNovi,Informatics Senior Specialist, Special Investigations Unit, Cigna

Douglas Rahden, MPH, CPMA, Core Analytics Team Lead, Special Investigations Unit, Cigna


ROUNDTABLE DISCUSSION: Reach the Holy Grail of Claims Excellence: Transforming the Member Experience through Dynamic Engagement & Communication

  • Tips to drastically reduce member complaints about the claims process
  • Best practices to establish the building blocks to enable dynamic member communication
  • Creating rapid response systems and feedback that enable substantive member responses
  • Staff training so the weakest links in the chain are effectively addressed
  • What are the best-in- class standards we need to strive for?


Thomas Everett, Senior Director, Claims Audit, Leading Health Plan

Adria Gross, CEO,Medwise Insurance


Close of Day One; Networking Reception Follows

Friday, October 27, 2017

Network Breakfast


Chairperson's Recap of Day 1


Leveraging Operational Intelligence and Automation to Optimize Claims Operations -- Improve Auto-Adjudication Rates

  • Real-world experiences in automated auto-adjudication
  • Lessons learned that can transform claims operations
  • Determining where maximum benefits accrue from intervention/re-design
  • Benefits and pitfalls of claims automation

Mark Belford,CareFirst BlueCross Blue Shield


Best Practices to Achieve Administrative Cost Management through an Effective Payer/Provider Partnership

  • Checklist for effective payer/provider collaboration
  • How to develop a working methodology that creates mutual benefit
  • Understanding key cost drivers from both the payer and provider perspectives
  • Determining the best intervention points for collaboration
  • Examples of real-world successes

Rich Dowell,Director - Network Service Enablement,United HealthCare (UHC)


Key Insights to Build & Implement a Successful Compliance Program

  • Proactive measures for a successful & compliant revenue cycle management
  • Learn about current OIG fraud cases from a subject matter expert perspective
  • Tips and strategies to conduct a successful claims audit and risk management assessment
  • Insights to prevent fraud, waste and abuse

Michelle Ann Richards BSHA, CPC, CPCO, CPMA, CPPM-I,Owner Coding & Compliance Experts


Networking Break


From Where I Sit: A Front-Line Perspective of the Member/Payer Claims Challenges

A lot of member goodwill is squandered unnecessarily through ineffective communications based around claims issues. This session brings key perspectives from the trenches to help all sides of the claims equation reengineer their processes and perspectives to safeguard the critical member relationship.

  • Most common elements of member/payer conflict centered around claims
  • Understanding the real problems and devising effective solutions
  • Creative solutions to the most common friction points

Adria Gross,CEO, Medwise Insurance


Creating Pristine "Clean" Claims - Essential Practice to Maximize Cost Containment

  • Share clean claims guidelines to prevent delays and ensure accuracy
  • Insights to prevent the rework and how to identify problematic areas
  • Discuss the importance of communication between payers and providers to minimize errors
  • Understand the importance of using proper coding

Speaker To Be Announced


Conference Concludes