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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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™ 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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SCIOXpert™

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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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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