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Medicare & Medicaid
SCIO® understands Medicare and
Medicaid — and delivers unsurpassed results in payment integrity.
Public health plans face unique quality and cost containment challenges.
With experienced resources dedicated to addressing these specific demands, SCIO Health Analytics provides innovative solutions that enable Medicare and Medicaid contractors to:
- Improve care management efforts by more accurately segmenting Medicare and Medicaid populations
- Better identify, pursuing third party liability (TPL) claims
- Effectively audit and recover specialty pharmaceutical implantable device overpayments
- Ensure payment integrity by reimbursing claims more accurately
- Analyze claims data to develop utilization, clinical outcomes and other vital metrics
Our suite of solutions:
Care & Risk Management
Delivering healthcare analytics tools and expertise to help improve member identification, facilitate program design and execution, enhance population health, and produce defensible ROI.
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Payment Integrity
Helping health payers control costs associated with third party liability, and incorrectly billed or overpaid health claims — to reduce overall health claim expenditures.
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Consumer & Employer
Providing actionable data to help plans and their customers identify the best opportunity for improved health and clinical outcomes, and achieve cost avoidance through the use of value based benefit designs and incentives/disincentives.
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Network & Provider
Analyzing the impact of changes in provider contracts, identifying high-trend providers, and delivering reports and recommendations to help network teams uncover opportunities for improving provider relationships and delivering better results.
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