HI SB2407

Directs the Department of Human Services to establish a provider data verification system to delete deceased providers, identify sanctioned providers, note license expirations, identify retired providers, and confirm current provider addresses for Medicaid, QUEST, and CHIP programs.

Requires implementation of clinical code editing technology to automate claims resolution, identify billing errors, and prevent overbilling using widely accepted protocols from the American Medical Association and Centers for Medicare and Medicaid Services.

Mandates deployment of predictive modeling and analytics to identify high-risk billing patterns, prioritize transactions for review before payment, and prevent payment of potentially fraudulent or wasteful claims until verified.

Requires implementation of fraud investigative services combining retrospective claims analysis and prospective detection techniques, plus claims audit and recovery services to identify improper payments and recover overpayments.

Requires the Department to report to the legislature by 2014 on implementation status and by 2015 on final results, including projected and actual cost savings, with intent that savings achieved will exceed implementation costs.