09
Recovery auditing software; computer software for tracking
claims of vendor overpayments; data mining software; data
analytics software
16
Printed materials, including brochures, books, newsletters,
magazines, reports, newspapers, manuals, pamphlets, journals
and printed guides in the field of account auditing,
consulting, software, business support and analysis
services
35
Account auditing services, including recovery audit services
in the nature of reviewing accounts payable, purchasing
systems, durable medical equipment payments, pharmacy claims
and transactions, freight and vendor records, and medical
claims billing systems to detect lost profits through
overpayments, miscalculations, missed discounts, pricing
errors, duplicate payments, incorrect invoices and missed
credits, sales and use tax liabilities and payments, and
contract and provider compliance; business consulting
services, including providing procure-to-pay process
improvement recommendations and providing industry
benchmarks to gauge performance and guide policy decisions;
business assistance, advisory and consulting services in the
field of health care claims coding, billing patterns
analysis, cost controls, payment policies, provider
utilization patterns analysis, provider billing compliance
review and analysis, integrated medical claims analysis,
medical charts, product liability analysis, medication
therapy management, and retro-termination claims review and
analysis; providing business financial opportunity and cost
analysis; healthcare business management services, namely
network utilization analysis; providing chart review
services as part of business management in the healthcare
field; business consulting services in the cost and payment
management of health care; medical claims management
services, namely, receiving, data entering, and re-pricing
of transactions that are originated by physicians,
hospitals, and ancillary medical care providers; medical
cost management; business assistance, advisory and
consulting services in the field of healthcare network
management; clinical and business process optimization
services; business decision support, analytics and
operations assessment services in the healthcare and retail
fields; comparative business and industry trend reporting
and analysis services; business process management of
clinical payments; retail transactions, promotions and
pricing review services; business and management consulting
for healthcare providers, retail companies and related
businesses; business data analytics services; business
management consulting; business consulting; electronic data
collection and data submission services for business
purposes in the fields of medicine and healthcare; business
information for enterprises; cost management for the
healthcare benefit plans of others
36
Medical insurance case and utilization review and insurance
claims adjustment services for healthcare purchasers and
payers and providers and Medicare beneficiaries; medical
insurance claims review services, including inpatient claims
analysis, medical claims evaluation and management, network
optimization and clinical and coding review services;
healthcare benefit financial management services; providing
healthcare benefit financial services; providing financial
counseling and consulting in the field of healthcare
benefits; insurance claim processing consultation services
for payer owned PPOs to eliminate out-of-network claims
38
Electronic data interchange services in the field of
healthcare transactions such as claims, eligibility, claim
status, electronic remittance advice, prior authorizations,
attachments and referrals that allow direct transaction and
payment communications between healthcare providers and
payers
42
Hosting a website for use in recovery auditing featuring
technology that enables users to store, track, analyze,
communicate, and report on information from multiple
recovery audit sources and audit efforts; IT consulting
services; providing on-line, non-downloadable,
Internet-based software application for medical billing for
physicians and health care institutions; technical data
analysis in the field of healthcare services, in the nature
of providing information on the subject of healthcare
provider profiling; mobile application development; hosting
a website featuring technology that enables users to manage
the vendor claim approval process; providing on-line,
non-downloadable software for use in the data analytics
field; computer services, including hosting an interactive
web site that allows storing, tracking, analyzing,
communicating and reporting on recovery audit activity and
the results of analysis of accounts payable, purchasing
system and medical claims billing transactions; application
service provider featuring software for providing an online
database in the field of transaction processing to upload
transactional data, provide statistical analysis and produce
notifications and reports; application service provider,
including providing, hosting, managing, developing,
researching, analyzing, reporting and maintaining
applications, software, web sites, healthcare benefits
programs, employee productivity and risk management;
developing customized software in the field of recovery
auditing for others; hosting an interactive business
customer accounting website that allows business owners to
retrieve customer data and audit customer accounts
45
Providing fraud and abuse support in the healthcare
industry; fraud detection services in the field of health
care insurance