REVIEWER: Darick Jarvis, systems manager for EDIWatch, Inc.

BACKGROUND: EDIWatch, Incorporated is the leading provider of antifraud solutions to the health care payer industry. Using more than 20 years of experience, EDIWatch has pioneered rules-based technology for health claims fraud detection, pre-adjudication and underwriting, and provides a complete suite of products for insurance carriers and TPAs to meet the growing need for an antifraud solution in the global economy. Clients are implementing this solution in departments such as Medical Affairs, Internal Audit and Provider Relations to improve productivity, efficiency and maximize significant savings to the payer. EDIWatch uses claims data, extensive rule sets, pattern matching, and internal and external reference data to guarantee increased productivity of investigative units, improved provider information for auditors and pattern documentation for adjudication. In particular, EDIWatch's SPOT (Systematic Profiling on Time) application is a fraud knowledge base containing rules and alerts that also takes patterns of behavior and historical data into account.

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