Assess whether a SAR narrative is supportable today (0849a9)

Situation

Credit and Identity Fraud work in a P&C carrier's auto-body network now turns on a SAR narrative is because a 400% utilization jump in 11 days put Medicare upcoding CPT pairing table in play. Wire-desk escalation officer should say what Medicare upcoding CPT pairing table proves.

Decision

Wire-desk escalation officer in a P&C carrier's auto-body network must choose Remove access or reverse the item / Temporary compensating control / Approve a documented exception / Hold using Medicare upcoding CPT pairing table after a 400% utilization jump in 11 days.

Hypotheses to test

• A 400% utilization jump in 11 days is noise around an already-controlled Credit and Identity Fraud process in a P&C carrier's auto-body network, given Medicare upcoding CPT pairing table.
• A 400% utilization jump in 11 days is the event in Medicare upcoding CPT pairing table that forces Remove access or reverse the item for wire-desk escalation officer under Fraud Detection.
• Medicare upcoding CPT pairing table shows a one-file miss after a 400% utilization jump in 11 days, not a Credit and Identity Fraud program failure.
• Medicare upcoding CPT pairing table cannot decide a SAR narrative is yet after a 400% utilization jump in 11 days; hold is the only Fraud Detection close a P&C carrier's auto-body network can defend.

Analysis required

• Trace funds, counterparties, and reversals in Medicare upcoding CPT pairing table through the window opened by a 400% utilization jump in 11 days.
• Quantify loss if the hold is released before Medicare upcoding CPT pairing table is complete.
• Test a one-off dispute against the first edge of a scheme around a SAR narrative is.
• For this Fraud Detection Credit and Identity Fraud file, read Medicare upcoding CPT pairing table against a 400% utilization jump in 11 days and write the one fact that would move a SAR narrative is for wire-desk escalation officer.

Recommendation

Choose Remove access or reverse the item / Temporary compensating control / Approve a documented exception / Hold on this Fraud Detection / Credit and Identity Fraud packet (Medicare upcoding CPT pairing table after a 400% utilization jump in 11 days). Lead with the Fraud Detection option Medicare upcoding CPT pairing table can support after a 400% utilization jump in 11 days, then the two facts that force it, then the Monday action for wire-desk escalation officer in a P&C carrier's auto-body network.