Actuarial services
Claims forensics and data integrity
Find out what your payer file is actually telling you
The engagement
Before you trust the answer, test the file.
Payer extracts arrive with silent defects: files cut off at row limits, paid amounts repeated where they should not be, multiple versions of the same claim with nothing marking which one is real. Every per-member cost, every settlement estimate, and every board slide built on that file inherits its errors.
Most teams find out late, if at all. The spreadsheet opens, the columns look right, and the analysis begins.
How Ariv approaches it
Verdicts on the feed, not just the figures.
An Ariv forensics engagement starts from the position that no raw file can be taken on face value. We profile the structure, completeness, and adjudication history of every feed, document what is wrong with it, and record every correction as a versioned ruling. What you get back is a certified analytical baseline, and a written trail from every number to the file it came from.
Findings from the field
What this work finds in practice.
1,048,575
The file ended where the spreadsheet does
A payer claims extract arrived silently truncated at the spreadsheet row limit. Forensic review caught it before it understated a year of experience.
19x
Paid amounts repeated on every line
Header-level paid amounts were duplicated across claim lines. Summed naively, spend was overstated nineteen-fold. The corrected figure reconciled to the cent against an independent hand-built analysis.
20 to 1
Duplicate adjudication versions
The same claim line arrived in up to twenty adjudication versions with nothing in the file to say which was current. A final-action rulebook kept only the version that counts.
Engagement details are shared with client identities removed.
How we work
- 01
Intake
Profile the feed
Structure, completeness, and adjudication history reviewed against a standing checklist before anything is computed.
- 02
Rulings
Rule on every defect
Each finding becomes a proposed correction; nothing applies until it is ratified, named, and dated.
- 03
Certification
Certify the baseline
A corrected analytical extract with a documented rulebook, ready to carry the analysis that follows.
Who we work with
Organizations that carry the risk.
- A value-based specialty group entering delegated risk
- An MSO reconciling multiple payer feeds
- A health plan validating a vendor extract