Find the Right HCFS Product

1. What’s your biggest priority right now?

Reducing pharmacy-related fraud and abuse Strengthening pre-payment fraud detection Automating SIU case workflows Improving diagnosis code accuracy and risk scores Maximizing audit recoveries and insights Automating and prioritizing investigative leads

2. Where does your team spend the most time today?

Manually reviewing pharmacy claims Chasing down leads from multiple systems Conducting post-pay audits Investigating upcoding or coding inconsistencies Managing member or provider reporting manually

3. Which best describes your current fraud detection process?

Mostly reactive, post-pay Mix of manual and rules-based detection Limited integration across systems Looking to adopt AI and automation Already advanced, but want to optimize results

5. What kind of outcomes matter most to you?

Faster fraud detection and savings Streamlined investigations and SIU productivity Regulatory compliance and audit preparedness Value-based care support and coding accuracy Comprehensive visibility across payment integrity

6. How important is cross-plan collaboration and trend-sharing?

Extremely important—we need broader visibility and benchmarking Somewhat important—we compare data selectively Not a focus at this time

7. What best describes your interest in AI for fraud detection?

High—ready to deploy or expand AI capabilities Curious but exploring options Limited interest right now