Confidential. This presentation is provided for the recipient only and cannot be reproduced or shared without Fair Isaac Corporation's express consent. © 2011 Fair Isaac Corporation. 1 Insurance Fraud Manager User Group February 8-9, 2011 San Diego, CA What’s New in 3.2 A New Model and New Summary Reports Co-partner Logo Andrea Allmon FICO Product Management Ben Friesen FICO Product Management

© 2011 Fair Isaac Corporation. Confidential. 2 2 Agenda »Independent Diagnostic Testing Facility Model »Search »Summary Reports »Provider »Member »Reporting »Assistance »Partner Features

© 2011 Fair Isaac Corporation. Confidential. 3 Entity Scoring Major Feature Description Entity Scoring  Rendering/Performing Provider (US)  Pharmacy (US)  Dental (US & Netherlands)  Independent Diagnostic Testing Facilities (US)

© 2011 Fair Isaac Corporation. Confidential. 4 Independent Diagnostic Testing Facilities The Independent Diagnostic Testing Facility (IDTF) Model is to capture and identify misuse of laboratory and other diagnostic procedure codes which are performed by the test facility. An Independent Diagnostic Testing Facility is a fixed location or mobile entity that is independent of a hospital or physician's office, where diagnostic tests must be performed by licensed, certified, non- physician personnel under the supervision of a physician.

© 2011 Fair Isaac Corporation. Confidential. 5 Reason Codes »Age Groups »Age Groups by Diagnosis Groups »Age Groups by Diagnostic Procedure Groups »Diagnosis Group Mix »Diagnostic Procedures »Diagnostic Procedure Mix »Diagnostic Procedure Upcoding »Independent Diagnostic Testing Facilities Member List »Members per Week »Members per Month »Member Sharing (Annual) »Member Sharing (15 Days) »Members without Services after Diagnostic Procedure »Members with Prior Services from Diagnostic Provider »Members without Services Prior to Diagnostic Procedure »Place of Service Group Mix »Selected Diagnostic Procedures »Selected Modifier Activity

© 2011 Fair Isaac Corporation. Confidential. 6 Search Major Feature Description  Save Search  Select Fields  Count of Results  Export Results

© 2011 Fair Isaac Corporation. Confidential. 7 Search Count and Export

© 2011 Fair Isaac Corporation. Confidential. 8 Exporting Searches

© 2011 Fair Isaac Corporation. Confidential. 9 Investigative Case Management Major Feature Description  Customizable Case Codes  System messaging  Activity Reminders/Tickler Functionality  Audit-proof log  Referral/Triage Status  Track case assignments  Track case sources  Track investigative activities  Track case costs  Mass case reassignment  Track case recoveries  Ability to link cases  Track case notes  Ability to attach files to cases  Ability to develop custom queues for entities under investigation  Correspondence generation  Entity Flagging  SIRUS Identification  Mass case creation In-depth Summary Information  Provider Statistics  Provider Group Information  Member Statistics  Pharmacy Statistics

© 2011 Fair Isaac Corporation. Confidential. 10 In-Depth Summary Information 1/1-12/311/1-3/314/1-6/307/1-7/31 »Collect one year of data »Wait three months to gather late claims »Send to FICO for modeling »Filter for providers with enough activity in Medical Claims »Deploy results (as much as 19 months after the fact) »Create “Model Summary Statistics” only for Medical Model Old Process

© 2011 Fair Isaac Corporation. Confidential. 11 In-Depth Summary Information »New Process 1/1-12/312/1-1/313/1-2/28 »Data is scored monthly »Models are always current »Statistics are by data type (not by model). Statistics available no matter which models have been run »Statistics are always current »Architected for cross-data statistics (Medical/Pharmacy and soon Facilities) »Architected to allow cross-data modeling

© 2011 Fair Isaac Corporation. Confidential. 12 Summary Screens

© 2011 Fair Isaac Corporation. Confidential. 13 Provider Summary Report

© 2011 Fair Isaac Corporation. Confidential. 14 Improved Member Summary

© 2011 Fair Isaac Corporation. Confidential. 15 Reporting Features Major Feature Description Breadcrumbs Investigative Reports  Report By Reason Code Management Reports  Case Listing  Case Details  Claim Line Case Status  Queue Inventory Reports  Savings Reports both Paid and Allowed Dollars Security/Audit Reports  User List  Billing Reports General Report Features  Improved Paging

© 2011 Fair Isaac Corporation. Confidential. 16 User List

© 2011 Fair Isaac Corporation. Confidential. 17 $0.025 $22, $10,000

© 2011 Fair Isaac Corporation. Confidential. 18 Assistance Features Major Feature Description  On-Line Help

© 2011 Fair Isaac Corporation. Confidential. 19 Security and Login Features Major Feature Description  Role Based Security  Forced Password Expiration and Format  Single Sign On

© 2011 Fair Isaac Corporation. Confidential. 20 Single Sign On »Allows site deployed users to by-pass the log on screen and use their network authentication »Allows partners to deploy in a shared portal environment

© 2011 Fair Isaac Corporation. Confidential. 21 Partner Features Major Feature Description  Private Labeling  Multi-payor Medical Claims Model

Confidential. This presentation is provided for the recipient only and cannot be reproduced or shared without Fair Isaac Corporation's express consent. © 2011 Fair Isaac Corporation. 22 Insurance Fraud Manager User Group February 8-9, 2011 San Diego, CA THANK YOU