© 2014 Fair Isaac Corporation. Confidential. This presentation is provided for the recipient only and cannot be reproduced or shared without Fair Isaac Corporation's express consent.

IFM 4.0 Reporting Framework

Allyn PonSenior Product Manager, IFMFICO

FICO® Insurance Fraud Manager User Group:San Diego, CA | May 7--8, 2014

2 © 2014 Fair Isaac Corporation. Confidential.

IFM Reporting Tree Today

Medical Dental Pharmacy Management

3 © 2014 Fair Isaac Corporation. Confidential.

Our Challenge

► How to make it easier for users to understand which reports are available

► How to make it easier for users to find the right report

► How to replicate 600+ reports without rewriting every single one

► Provide a foundation for developing new reports that is easier

► Complete this effort within a major development cycle

© 2014 Fair Isaac Corporation. Confidential.4

IFM Data Visualization and Reporting

5 © 2014 Fair Isaac Corporation. Confidential.

IFM Today

Oracle

BusinessObjects

► IFM has over 600+ reason code “reports”► Most reason code reports compare suspect

provider to peers► Business Objects generate both data

visualizations and reports► For IFM 4.0, Significantly enhanced usability of

data visualizations and workflow for reporting, based on a new FICO reporting framework

6 © 2014 Fair Isaac Corporation. Confidential.

4.0 Discussions – Report Types

CurrentProposed

» Today» Top 10 (Bar Chart)» Comparison Charts (Clustered Column Charts)» Distribution Charts (Line + Bar Chart)

Comparison Charts

7 © 2014 Fair Isaac Corporation. Confidential.

New FICO Reporting Framework

► New FICO Reporting Framework is based on metadata

► Metadata summarizes basic information about data, which can make

finding and working with particular instances of data easier. For

example, author, date created and date modified and file size are

examples of very basic document metadata.

8 © 2014 Fair Isaac Corporation. Confidential.

Benefits to New FICO Reporting Framework

► Faster Response Times

► More control over data visualization output

► More visually pleasing

► Flexibility to place derived visualizations/reports at various locations within the application

► Improved Ease of use - Less clutter

9 © 2014 Fair Isaac Corporation. Confidential.

Reports in IFM Today Will Still Be in IFM 4.0

Inventory

Claims by Queue

Claims by User

Claims by Status

User Deny Claim Cases

Claim Line Cases

Case Management

Case Data

Recoveries

Costs

Management

Family Affiliations

Financial Breakdown

% Claim Lines/Procedure

% Dollars/Procedure

% Claim Lines/Diagnosis Grp

% Dollars/Diagnosis Grp

Top 5 Days by Dollars

Top 5 Providers By Drug

Top 5 Procedures By Dollars

Top 5 Drug Groups by Dollars

Procedure Summary

Member Summary

Financial Breakdown

% of Dollars/Month

Member Breakdown

Claim Lines by Age & Gender

Procedure Breakdown

% Dollars by Procedure Grp

% Dollars by Diagnosis

Time Breakdown

$ Per Drug Grp

Diagnosis Breakdown

Top Days (By $, Procedures,

Provider Summary(Rendering & Billing)

Procedure Grp Mix

Diagnosis Grp Mix

TOS & POS Grp Mix

Age/Gender Mix

Member Consecutive Visits

Per Day Activity

Per Member Volume

Procedure Grp Activity (Dollars)

Procedure Grp Activity (Top 10 % of Claim Lines)

Reason Codes

10 © 2014 Fair Isaac Corporation. Confidential.

IFM 4.0IFM Reporting vs Visual Insight Studio

► IFM Reporting Framework and Visual Insight Studio are two different functions and capabilties

► IFM Reporting Framework is custom developed to meet our visualization and reporting needs

► IFM Reporting Framework is included within the IFM application

► Visual Insight Studio is a separate add-on license for hosted customers

11 © 2014 Fair Isaac Corporation. Confidential.

IFM 4.0Data Visualizations and Reports

► Data Visualizations (Reason Code Reports) will be moved to the Provider Summary module under the Analytics subtab

► Management Reports will remain and launched from a Reporting Tab

► Will deliver all management and inventory reports currently available in IFM

► Need your help to filter out which reports are important or need to be changed

► Data for the new reports will be sourced either from Oracle or from MongoDB, depending on the nature of the report and the required response

► Oracle tables remain as the single point of truth

© 2014 Fair Isaac Corporation. Confidential. This presentation is provided for the recipient only and cannot be reproduced or shared without Fair Isaac Corporation's express consent.

Thank YouAllyn Pon(858) 369-8487allynpon@fico.com

FICO® Insurance Fraud Manager User Group:San Diego, CA | May 7--8, 2014