Assess whether a SAR narrative is supportable today (c5698e)

Situation

SIU investigator in a Medicare Advantage claims shop has one working extract — first-party friendly-fraud dispute pack — after a new device from a different metro on a 2am login. If first-party friendly-fraud dispute pack cannot support a SAR narrative is, the honest Fraud Detection output is hold.

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 first-party friendly-fraud dispute pack after a new device from a different metro on a 2am login.

Hypotheses to test

• First-party friendly-fraud dispute pack reads as Remove access or reverse the item once a new device from a different metro on a 2am login is lined up to the same Fraud Detection population.
• First-party friendly-fraud dispute pack is closer to Temporary compensating control after a new device from a different metro on a 2am login; Remove access or reverse the item would over-claim this Claims and Benefits Fraud extract.
• Approve a documented exception is still live in first-party friendly-fraud dispute pack for SIU investigator in a Medicare Advantage claims shop.
• First-party friendly-fraud dispute pack is missing the fact SIU investigator needs after a new device from a different metro on a 2am login; stop this Fraud Detection close.

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 first-party friendly-fraud dispute pack.
• 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 first-party friendly-fraud dispute pack against a new device from a different metro on a 2am login 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 (first-party friendly-fraud dispute pack after a new device from a different metro on a 2am login). Lead with the Fraud Detection option first-party friendly-fraud dispute pack can support after a new device from a different metro on a 2am login, then the two facts that force it, then the Monday action for SIU investigator in a Medicare Advantage claims shop.