ifm 4.0 reporting framework
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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. - PowerPoint PPT PresentationTRANSCRIPT
© 2014 Fair Isaac Corporation. Confidential. This presentation is provided for the recipient only and cannot be reproduced or shared without Fair Isaac Corporation's express consent.
IFM 4.0 Reporting Framework
Allyn PonSenior Product Manager, IFMFICO
FICO® Insurance Fraud Manager User Group:San Diego, CA | May 7--8, 2014
2 © 2014 Fair Isaac Corporation. Confidential.
IFM Reporting Tree Today
Medical Dental Pharmacy Management
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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
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IFM Data Visualization and Reporting
5 © 2014 Fair Isaac Corporation. Confidential.
IFM Today
Oracle
BusinessObjects
► 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
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4.0 Discussions – Report Types
CurrentProposed
» Today» Top 10 (Bar Chart)» Comparison Charts (Clustered Column Charts)» Distribution Charts (Line + Bar Chart)
Comparison Charts
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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, date created and date modified and file size are
examples of very basic document metadata.
8 © 2014 Fair Isaac Corporation. Confidential.
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
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Reports in IFM Today Will Still Be in IFM 4.0
Inventory
Claims by Queue
Claims by User
Claims by Status
User Deny Claim Cases
Claim Line Cases
Case Management
Case Data
Recoveries
Costs
Management
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
Member Summary
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,
Provider Summary(Rendering & Billing)
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)
Reason Codes
10 © 2014 Fair Isaac Corporation. Confidential.
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 © 2014 Fair Isaac Corporation. Confidential.
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
© 2014 Fair Isaac Corporation. Confidential. This presentation is provided for the recipient only and cannot be reproduced or shared without Fair Isaac Corporation's express consent.
Thank YouAllyn Pon(858) [email protected]
FICO® Insurance Fraud Manager User Group:San Diego, CA | May 7--8, 2014