As a Program Safeguard Contractor (PSC), AdvanceMed Corporation assumed responsibility of all Benefit Integrity (BI) functions and Post Payment Medical Review functions for Ohio Part B Services on July 1, 2002, and Ohio Part A Services on June 1, 2003. Benefit Integrity functions for Kentucky Medicare Part A and Part B Services were added to the contract on December 1, 2005. Minnesota Part A BI and post-pay Medical Review were added on November 1, 2008.  The BI functions include investigation of suspected Medicare fraudulent activities, as well as investigation of any fraud complaints received by the PSC, data analysis to support fraud investigation, and pre-payment and post-payment medical review of claims to support BI activities. The Medical Review functions include post-payment claims review, overpayment calculation and provider education.

The AdvanceMed OH/KY/MN contract performs the following functions for CMS as a PSC:

• Medicare data analysis (discovery, detection, investigation, and overpayment projection);
• Medical Review (post-payment medical review and medical review to support fraud case development – Part A and Part B claims review);
• Medicare fraud investigation and prevention;
• IT Systems for case and decision tracking and data warehousing;
• Interface with the Medicare contractors, the medical community (outreach & education), and law enforcement; and
• Medicare/Medicaid data matching program safeguards work for the state of Ohio.