decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
Medicare_Carriers_Manual / 14006 / 14006.2_UTILIZING_ARGUS_SYSTEM
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Article Overview
This Medicare Carriers Manual article covers the ARGUS system, a claims-data review tool used by the Office of Inspector General and carrier fraud units. It explains the system’s purpose, the type of claims information it processes, the structure of investigative files, and the general data formatting and transmission conventions used when responding to authorized requests. It is relevant to compliance, fraud investigation, and Medicare claims administration staff who handle data requests.
Why This Topic Matters
Understanding ARGUS helps carriers and investigative staff recognize how claims data is assembled, formatted, and shared for review. The article supports consistent handling of provider data requests and broader fraud-detection workflows.
What You Will Learn
- The purpose of the ARGUS system in claims-data review
- How investigative files are organized at a high level
- The general formatting conventions used for requested data
- The basic method for furnishing data to authorized requestors
Who Should Read This
- Medicare carrier staff
- Fraud unit personnel
- Compliance professionals
- Healthcare auditors
- Investigative staff
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