SCIO Health Analytics Launches SCIOMine™ Payment Integrity Analytics and Audit Workflow Software Suite
Health plans and PBMs benefit from better analytics, more streamlined auditing process, reporting and improved productivity and throughput
WEST HARTFORD, Conn.--(BUSINESS WIRE)--SCIO Health Analytics®, a leader in actionable healthcare analytics solutions, today announced the launch of SCIOMine™, an advanced Payment Integrity analytics and audit workflow and reporting software suite.
“With the industry experiencing an increase in the volume of improper payments, the need for this type of complete solution grows as well.”
SCIOMine enables health plans and pharmacy benefit managers (PBM’s) to make informed decisions by identifying, investigating and monitoring claims payment issues including billing issues, waste, errors and overpayments. SCIOMine also streamlines the entire audit process, maintains an audit trail, helps in the recovery and reconciliation process, improves productivity and provides advanced reporting capabilities.
“While SCIOMine™ was originally developed as internal software to help manage our clients’ audits, we eventually realized that companies who perform their own fraud, waste and abuse and overpayment audits could significantly benefit from a similar solution to help manage the complexities of payment integrity identification, audit and reporting processes. Internally, we have seen improvements of up to 8-10 times the ROI from using a streamlined process,” explained Siva Namasivayam, CEO, SCIO Health Analytics. “With the industry experiencing an increase in the volume of improper payments, the need for this type of complete solution grows as well.”
SCIOMine can generate a compelling 6-12 month payback for payment integrity departments. This software suite is targeted at payment integrity, financial recovery, claims processing, pharmacy fraud and compliance, special investigation (SIU) departments of commercial, managed Medicare, managed Medicaid, exchange plans, health systems, and PBMs.
SCIOMine™ is modular and flexible based on specific business needs, including:
- Algorithms - Uses rules and logical queries to identify suspicious data resulting in errors and overpayments. SCIOMine provides flexible and customizable algorithms and process flows designed to meet individual client needs.
- Workflow - Improves business processes with automated routing and transfer of data across multiple areas for next step processing. SCIOMine provides the expertise and unlimited workflow designs for various user-types and departments to create a custom workflow. It re-engineers and accelerates the audit process, improves recoveries, manages auditor/claims analyst productivity, and retains supporting documentation to maintain program integrity.
- Medical Record and Document Management - Features include medical record requisition and management, letter generation and document management.
- Claims Reconciliation and Recovery - Customization of the claims payment reconciliation and the recovery and collection process.
- Business Intelligence and Reporting - Core features include: transaction, operational, and strategic reporting. SCIOMine reporting provides real-time transparency to assist in marketing business decisions and provides clients with the tools and services to help them understand their data better. In addition, SCIO Health Analytics provides custom analytics around opportunity and performance management.
About SCIO Health Analytics
Based in West Hartford, Connecticut, SCIO Health Analytics™ is a leading health analytics solutions company, leveraging the power of healthcare data, predictive analytics, and a team of experts to provide clients the tools to improve wellness and quality, decrease costs and missed opportunities, and drive ROI and sustainability. Since 2008, SCIO’s commitment to analytics-driven outcomes and health technology has produced $275 million in annual savings for clients across multiple markets which include health plans, employers, specialty vendors, and bioscience firms. To learn more, visit www.sciohealthanalytics.com.