SCIO’s Payment Integrity Solutions help Payers, Health Plans and PBMs control costs associated with third party liability and incorrectly billed or overpaid health claims – to reduce overall health claim expenditures. Our products and services target other party liability, fraud, waste and abuse via a complete line of subrogation, claim audit and overpayment programs, and data mining solutions.
SCIOMine™ is a browser-based medical and pharmacy claims audit workflow tool designed to cater to customized payment rules and reimbursement methods.
MY SOCRATES®, our state-of-the-art customizable, paperless, subrogation case management software, offers a stand-alone subrogation solution from identification to recovery.
Medical Claims Auditing
Our medical claim auditing services ensure our clients are controlling costs most often associated with incorrect billing and overpaid medical claims, improving both administrative and medical loss ratios.
Pharmacy Claims Auditing
Our pharmacy claims auditing services focus on pharmacy compliance, overpayment identification, and/or fraud.
Our claims audit capabilities include:
- Data Mining
- Contract Review
- Payment Policy Review
- Clinical Review
- Fraud, Waste and Abuse Review
- Other Party Liability and Subrogation Review
SCIO® maximizes payment integrity effectiveness with a “full cycle” approach to claims auditing, by focusing on prevention, avoidance and recovery.