VERISK HEALTHCARE

Computer software for use in diagnosis-based risk adjustment in the healthcare industry and related instructional manuals sold therewith; computer software for risk assessment and predictive modeling in the healthcare industry and instructional manuals sold together therewith

Providing health care utilization and review information services regarding health care cost management for revenue recovery opportunities and processing of healthcare information particularly to identify missed or incorrect coding, and quality problems and initiatives; Providing business marketing data to healthcare businesses, healthcare providers and others in the healthcare market regarding the costs of financing, organizing and providing health services; compiling and analyzing statistical health data in order to uncover and identify health care fraud and claims errors

Providing prepayment cost reduction services by performing financial analysis of suspect claims to insurance companies and other payors of health care claims

Providing temporary use of non-downloadable software applications for analyzing, creating financial models of, and creating reports on, health care costs, the financing of health care costs, and the delivery of health care services, and for targeting specific business problems in the health care field, namely, identifying chronic conditions for care management, assessing health plan risk selection, determining renewal rates for health plans, and evaluating premium efficiency, over a global computer network; providing temporary use of online, non-downloadable software in the nature of a disease management calculator that helps clients understand their population's health care needs; providing on-line non-downloadable software to enable others to perform information and research services regarding the Medicare market, namely, to identify missed or incorrect coding, to identify revenue recovery opportunities, and to identify quality problems and initiatives in health care data; providing on-line non-downloadable software to health care businesses, health care providers and others in the health care market, namely, data warehousing software, reporting software, business intelligence software and predictive modeling software; providing temporary use of on-line, non-downloadable software for performing cost and risk analysis, cost control analysis, and data analysis, modeling, reporting, and warehousing for use in the health care industry, managed care provider groups, self-insured employers, and third-party business administrators; for amending and profiling healthcare provider billing activity in order to identify and prevent patterns of fraud and abuse, for preventing overpayments, rules violations, and clinical mistreatment by analyzing healthcare claim submissions, for reducing healthcare facility claim costs, diagnostic related groupings and ambulatory payment classification expenditures by identifying fraud, abuse, and overpayments to maximize claims payment accuracy, identify fraudulent facilities, and clinically validate claim submissions, for reducing dental benefit claim costs by identifying fraud, abuse, and overpayment to maximize dental claims payment accuracy, identify fraudulent providers, and clinically validate claim submissions, for reducing professional claims costs by identifying fraud, abuse, and overpayments in order to maximize claim payment accuracy, identify fraudulent providers, and clinically validate claim submissions, for identifying fraud and abuse in the submission of insurance claims and overpayment of insurance claims and for creating predictive models of future insurance claims; development of software for others for use in analyzing, compiling and exploiting statistical health data; providing data conversion of computer program data, data analysis and development of data reporting software in the healthcare and health insurance industry and providing consulting services thereto