Overpayments cost health plans and payers billions of dollars each year. To recover and prevent the overpayments, health plans must often manage audit programs 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 plans cost-containment efforts.

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 a suite of reports and dashboards.

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