Business Process Details - Identify Utilization Anomalies
Guidance for the Identify Utilization Anomalies business process that uses criteria and rules to identify target groups (e.g., providers, contractors, trading partners or members) and establishes patterns or parameters of acceptable and unacceptable behavior, tests individuals against these models, or looks for new and unusual patterns, in order to identify outliers that demonstrate suspicious utilization of program benefits.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: February 01, 2012
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