Fraud investigationProcess
In-depth review and determination of whether a claim involves fraud
Outgoing relations
- GOVERNED_BYFraud threshold policyPolicyclaim over $25,000 with two or more fraud indicatorsofficialclaims-fraud-investigation.md
- GOVERNED_BYFraud Exception to the Prompt Payment PolicyPolicyfor confirmed fraud casesofficialclaims-fraud-investigation.md
- HAS_STEPReview claim history in Policy Administration SystemStepofficialclaims-fraud-investigation.md
- PERFORMED_BYFraud Investigation UnitActorofficialclaims-fraud-investigation.md
- RELATES_TOOutside legal counselActorfor confirmed fraud casesofficialclaims-fraud-investigation.md
Incoming relations
None.