SCIO® provides advanced predictive analytics that incorporates a deep knowledge of industry coding rules, risk adjustment, quality measures, and regulations and clinical & claims review expertise. Our products allow precise selection and the ability to spot weaknesses in payer systems, data flow, and processes that contribute to errors.

The following are the key components of our reimbursement optimization programs:

Payment Integrity: Ensuring that claims are paid correctly assists payers in controlling costs associated with fraudulent claims, and reducing overall payment discrepancies, adjudication, and reimbursement expenditures. Our medical claims and pharmacy claims auditing services focus on prevention, pre-payment, post-payment.

Risk Adjustment: Risk score determines the revenue that payers receive every month. Risk adjustment analytics aligns revenue with expected costs of care and tracks HCC trends so organizations can more easily create suspect lists to support retrospective and prospective collection programs.

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