SCIOXpert® Consulting Services

SCIOXpert® consulting services pinpoint precise recommendations, prescribe actions, and operationalize insights. By leveraging deep clinical, technical and analytics expertise, we deliver insights for a variety of healthcare organizations.

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Data Integration & Management

SCIO® has been managing 80 terabytes of data on 100 million members, from 300 million unique claims. We provide data collection, aggregation, integration and management while maintaining accuracy and integrity.

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Medical Pharmacy & Claims Auditing

SCIO® conducts audits to identify incorrect billing and overpaid facility claims and also offers pharmacy claims auditing services. Our full cycle approach to claims auditing focuses on prevention, pre-payment and post-payment. Whether it is a desk audit or an on-site audit, clients can be rest assured that our sophisticated analytics, operational expertise and clinical knowledge will detect, prevent and recover the maximum number of improper payments.

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Prepayment Auditing

SCIO’s prepayment auditing solution enhances existing audit concepts by using sophisticated analytics, unmatched clinical expertise, and an efficient centralized platform to rapidly select and review claims well within a payer’s prompt payment window.

This enables payers to avoid - rather than recover - overpayments, streamline payment integrity programs, and generate increased savings on both medical and administrative costs. Prepayment analysis reduces a payer’s reliance on post-pay tactics and is particularly well suited for high dollar/high risk claims, claims from non-participating providers, and to combat quick-hit schemes.

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Chart Validation

SCIOClarity Chart Validation is a retrospective strategy wherein SCIO’s experienced staff coordinates the retrieval and auditing of member medical records from provider groups to maximize diagnosis code accuracy.

There are five elements to the SCIOClarity Chart Validation service:

1. Suspect List Creation using SCIOClarity Analytics

2. Primary Care Provider Engagement

3. Medical Record Acquisition

4. Chart Review and Coding

5. Reporting

The service is used by health plans as a part of their overall efforts to ensure optimal performance in their risk adjustment and quality programs.

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SCIOClarity™ Inpatient Data Pursuit

Hospital data pursuit, an important component of a health plan’s risk adjustment program, is the most reliable way to track patients and services rendered. SCIOClarity™ Inpatient Data Pursuit is a full-service hospital data collection service for health plans that eliminates missing and under-reported diagnoses codes related to inpatient stays.

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SCIOClarity™ Member Outreach & Provider Collaboration

Health plans and providers can now address gaps in care by collaborating and encouraging data transparency. Our services allow clients to engage providers and members with timely interventions to close the gaps resulting in potential savings and improved health and wellness of their patient populations. SCIOClarity™ Member Outreach & Provider Collaboration is a prospective end-to-end service for closing care gaps.

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SCIOXpert® is our advisory service that leverages SCIO’s deep industry domain knowledge, advanced predictive and prescriptive analytics capabilities, and subject matter expertise on patient-centric behavioral and commercial applications.

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