Frequently Asked Questions  What are overpayments? Overpayments can be defined as a single claim that has been paid needlessly more than once. We identify two type of overpayments, duplicate and ineligible for payment. Duplicates are claims that are paid more than once for the same service. We capture duplicate payments billed on the same day to the same -or- different providers for the same member and CPT code. We also identify claims that were paid when a member was ineligible. This can be caused by the provider not checking the eligibility of the member on the date of service or by retroactive terminations.   How does your service work? First, we require that you send us an extract of your claims and eligibility data. Since we accommodate our clients, you can submit the data any way you want (our competitors require you to create extract programs using their exact specifications). Some clients create an extract using Microsoft Access. Others create an extract using Crystal Reports and some clients have their IT department create custom extracts just for the purpose of submitting their files to us.   Regarding the extract, we feel very strongly about privacy. In order to do our analysis, we require only a few fields from your claim and eligibility files and demographics are not among them. By demographics we mean the name, address age and gender of your members. Unless you want these fields included in the feedback we send back to you, we have no use for them.   How do we send the extract to you? We can download it from your system via our high-speed internet connection using FTP or we can accept the extract on  CD’s and DVD’s.   How much does it cost to get an initial analysis of my claims database? We will analyze your claims for no up-front fees. If you are satisfied with the results and you think the recovery is worth pursuing, we charge a flat 10% net savings for each service line identified as an overpayment.   Can you do the recovery for us? No, Pilot Information Systems does not do recovery.   Do you do prospective analysis? Yes, some clients submit their claims to us prior to their weekly check run. We in turn will report back to them their overpayments at which time they would deny those claims prior to the payment cycle.    Do you do bundling, un-bundling, up/down coding? No, we only identify duplicate and ineligible claims. Since this is the only thing we do, we do it well.     Once we send you our claims, what can we expect? After we process your claims, we will present you with reports and a disk file that contains a small sampling of what we found. We expect you to compare the results from our analysis to the actual claims in your system and check for accuracy. We also will provide you with the total dollars that were found to be overpaid.   That’s nice, then what? If you feel that the results justify your purchase of the entire result set of data, upon payment we will send back to you - in the format of your choice, on the media of your choosing – the database file and supporting reports. Depending upon your system, you may be able to upload the claims and have your system automatically re-process the overpaid claims to deny or reverse them.   Is your software for sale? Our software is written for use on IBM’s AS/400 midrange system. We do license our software and will make modifications to the software that the client requests, free of charge. For more information follow the system licensing link. What is required to start using your service? Initially, we will send a letter of engagement that outlines what we will do and discusses our non-disclosure policy. In addition, we will send specification on the fields that we require in order to process your claims.

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