Assess whether a SAR narrative is supportable today (df44d9)

Situation

Three applications sharing one employer EIN and no payroll put Medicare upcoding CPT pairing table in front of SIU investigator in a Medicare Advantage claims shop. This Fraud Detection / Claims and Benefits Fraud close is a SAR narrative is from Medicare upcoding CPT pairing table, and the live options are Remove access or reverse the item, Temporary compensating control, Approve a documented exception.

Decision

SIU investigator in a Medicare Advantage claims shop must choose Remove access or reverse the item / Temporary compensating control / Approve a documented exception / Hold using Medicare upcoding CPT pairing table after three applications sharing one employer EIN and no payroll.

Hypotheses to test

• SIU investigator can defend Remove access or reverse the item from Medicare upcoding CPT pairing table after three applications sharing one employer EIN and no payroll in a Fraud Detection challenge.
• SIU investigator cannot defend Remove access or reverse the item from Medicare upcoding CPT pairing table; Temporary compensating control is what the extract actually supports after three applications sharing one employer EIN and no payroll.
• Three applications sharing one employer EIN and no payroll never reached the population in Medicare upcoding CPT pairing table — reopen intake, do not close a SAR narrative is.
• Two facts in Medicare upcoding CPT pairing table after three applications sharing one employer EIN and no payroll conflict for SIU investigator; hold this Claims and Benefits Fraud file.

Analysis required

• Test a one-off dispute against the first edge of a scheme around a SAR narrative is.
• Check mule or round-trip markers in Medicare upcoding CPT pairing table.
• Map typology and hold authority SIU investigator actually has in a Medicare Advantage claims shop.
• For this Fraud Detection Claims and Benefits Fraud file, read Medicare upcoding CPT pairing table against three applications sharing one employer EIN and no payroll and write the one fact that would move a SAR narrative is for SIU investigator.

Recommendation

Choose Remove access or reverse the item / Temporary compensating control / Approve a documented exception / Hold on this Fraud Detection / Claims and Benefits Fraud packet (Medicare upcoding CPT pairing table after three applications sharing one employer EIN and no payroll). Lead with the Fraud Detection option Medicare upcoding CPT pairing table can support after three applications sharing one employer EIN and no payroll, then the two facts that force it, then the Monday action for SIU investigator in a Medicare Advantage claims shop.