SCIOMine™

A browser-based medical and pharmacy claims audit workflow tool designed to cater to customized payment rules and reimbursement methods.

SCIOMine™

A browser-based medical and pharmacy claims audit workflow tool designed to cater to customized payment rules and reimbursement methods.

SCIOMine - how does it work?

Overpayments cost health plans and payers billions of dollars each year. To recover and prevent the overpayments, health plans must manage audit programs often without specifically designed tools or expertise.  

SCIOMine™ is a browser-based medical and pharmacy claims audit tool designed to cater to customized payment rules and reimbursement methods. SCIOMine integrates multiple sources of data and processes to manage the entire audit life cycle of a plan’s cost containment efforts.

Delivery methodology:

5 integrated applications power SCIOMine™

Data Management: supports routine intake and mapping of claims, membership and provider data into a structure to support end to end audit functions including reporting.
Selection: supports configurable payer rules engines and models for selection of claims for audit.  
Correspondence/ Communications: provides a centralized repository for all audit documentation that incudes outbound letters, requests, findings, as well as inbound responses and inquiries relating to an audit.
Workflow Management: supports the end to end assignment and routing of audits based on user defined parameters and provides transparency through detailed status and audit findings tracking of all individual audits.
Reporting: supports day to day managerial reporting of operations status and performance reports as well as program performance dashboards and scorecards for leadership.

PRODUCT BENEFITS

  • Centralize all audit activities for institutional, professional and pharmacy claims into one platform
  • Browser-based, modular and flexible to accommodate specific business rules and
    reimbursement methods
  • User-configurable workflows requiring no IT involvement
  • Flexibility to route audits based on multiple variables such as skill set or status
  • Automated Records Management System
  • Platform provides Payment Insights through suite of reports and dashboards

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On-demand Webinar



Predicting and Preventing Claim FWA with Advanced Profiling & Analytics

Held on: Thu, Sep 15, 2016

Predicting and Preventing Claim FWA with Advanced Profiling & Analytics

Learn how to manage your plan's entire audit life cycle with SCIOMine.

Learn how to manage your plan's entire audit life cycle with SCIOMine.

Key Product Features