Using customized algorithms in conjunction with custom-built databases, analytics, profiling, predictive modeling, and reporting results in PHG being able to provide clients the capability to identify and index fraud, perform proper benefit plan design, reduce spend, and the opportunity to offer additional benefits at a lower cost.

When offered, the anti-fraud and proper benefit plan design technology will:

• Contain indexed data on benefit plans, billing codes, and provider networks for analysis
• Offer analytics on benefit plan designs, member utilization, and quality controls
• Perform profiling of procedure code usage and provider treatment planning
• Execute predictive modeling and stratifying on members’ usage and provider fraud
• Provide analysis and recommendation reporting on benefit usage and negative happenings
• Create proper benefit plan designs for increasing benefits and reducing fraud (costs)

A majority of insurance carriers, self-funded companies, health maintenance organizations, third party administrators, administrative services organizations, and reinsurers that currently interact with the public sector (federal government, state agencies, local municipalities), the private sector (Corporate America, small business, non-profits, school districts, utility companies), and the Taft Hartley sector (labor unions) do not have the knowledge or capability for identifying the multiple types of fraud or the expertise to properly design benefit plans for maximizing their opportunities and preventing fraud.

PHG’s comprehensive anti-fraud and proper benefit plan design technology will include data bases with certified procedure codes, various types of dental plans, statistics on procedural code usage, dental networks, and conversion capabilities. The company’s proprietary software will have the capability to perform various analytic processes, provider profiling, benefit program analysis, and predictive modeling. The Company’s reporting will include identifying the types and mechanics of fraud, excessive and unnecessary spending areas, creating proper benefit plan design programs, opportunities for enhancing their existing dental benefits, and offering new and additional benefits without increasing their cost.

Developed, the initial components of the proprietary software will be:

• Data Base - benefit plans, claims statistics, and conversion of billing codes
• Analytics - for existing benefit plans, utilization, and quality controls
• Profiling - each provider’s usage of billing codes (industry norm versus used)
• Predictive Modeling - projection of in and out of network usage and costs
• Reporting - usage versus national average and proper benefit plan design

When provided, the anti-fraud and proper benefit plan design technology will:

• Contain indexed data on benefit plans, billing codes, and provider networks for analysis
• Offer analytics on benefit plan designs, member utilization, and quality controls
• Perform profiling of procedure code usage and provider treatment planning
• Execute predictive modeling and stratifying on members’ usage and provider fraud
• Provide analysis and recommendation reporting on benefit usage and negative happenings
• Create proper benefit plan designs for increasing benefits and reducing fraud (costs)

PHG uses the customized algorithms, data bases, analytics, predictive modeling, and reporting to provide clients the capability to identify and index fraud, complete proper benefit plan design, gain a reduction in spending, and the ability to offer more enhanced benefits without increasing their costs or reducing their current offerings… Guaranteed!

The anti-fraud and proper benefit plan design products will allow each client the capability to:

• Identify and index types of fraud, prevent future occurrences, and reduce their overall spend
• Enhance existing benefits while simultaneously adding new ones without increasing costs
• Create proper benefit plans without limiting access, increasing deductibles, adding co-pays or eliminating any current benefits.