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.

Services:

Medical Claims Auditing:

Our medical claim auditing services ensure our client’s control 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 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

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