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NCI AdvanceMed

Customer Challenges

Uncovering fraud, waste, and abuse requires refined methodologies and “big data” best practices applied to program-integrity vulnerability assessments, case management, investigative services, data management and analytics, medical record review, and medical record management.

Customer Benefits

NCI AdvanceMed plays an important role in improving the integrity of the U.S. healthcare system. Our specialized skill sets span information technology (IT) services, electronic health records management, data analysis, case management, medical review, and investigations. We provide fraud investigation, proactive data analysis, and secure IT infrastructure services. Our solutions use advanced analytic tools against diverse and high-volume data sets to support “big data” processing in our secure data center. Because our solutions capture comprehensive long-term billing history, leverage near-instant access to medical data when and where it is needed, and automatically identify potential medical practice miscoding, our medical professionals are able to efficiently and effectively uncover fraudulent activities. For maximum effectiveness, we complement advanced analytic needs with benefit-integrity analysts, fraud investigators, legal counsel, data analysts, and medical review specialists. Through these efforts, NCI AdvanceMed brings all the necessary elements to enable clients to successfully meet their objectives and mission needs.

About NCI AdvanceMed

NCI AdvanceMed, an NCI company, helps U.S. Federal agencies reduce improper payments by fighting fraud, waste, and abuse in entitlement programs. NCI AdvanceMed utilizes analytic techniques and automated tools to stop fraudulent activity before it gets to the entitlement system and to aggressively identify fraudsters who have already made it into the system. Our workforce delivers outcomes that reduce overpayments, improve understanding of policy and payment vulnerabilities, contain costs, eliminate backlogs, and improve documentation for case referrals and overpayment recoveries. Our services combine extensive practical medical coding knowledge with strategic analytical skills and law enforcement experience to ensure every task is conducted at the highest levels of efficiency and discretion. We are a Medicare Program Safeguard Contractor, a Zone Program Integrity Contractor, and a Review of Provider Medicaid Integrity Contractor. NCI AdvanceMed aligns with cutting-edge resources, analytics, and capabilities, allowing for progressive healthcare integrity in today’s fluid environment. Our comprehensive set of services includes the following:

  • Data Quality and Management
  • Advanced Statistical and Time-Series Analysis
  • Case Management
  • Fraud Investigation
  • Medical Coding Review
  • Medical Record Management
  • Secure Virtual Desktop Infrastructure Data Center Optimization

NCI’s AdvanceMed staff of nearly 500 employees consists of medical professionals, data analysts, medical record managers, fraud investigators, statisticians, IT support specialists, and program management professionals. Our medical professional staff consists of board-certified physicians, nurses, physical therapists, occupational therapists, speech language therapists, and other allied health professionals. Our past performance includes a broad spectrum of experience, and we have developed a comprehensive approach to fraud detection and prevention that utilizes our extensive resources.