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Brochure - Payment Integrity


Published on November 30, 2014

2 Contents An Overview Prevention Programs Pre-Pay & Post-Pay Solutions SCIOMine ™ Payment Platform SCIOMine ™ Highlights SCIOMine ™ Select SCIOMine ™ Workow SCIOMine ™ Insights Medical Claims Audits Claims Data Mining Hospital Bill Audits DRG/Short Stay Audits SNF/RUG Audits High Cost Drug Audits DME Audits Home Health Audits APC Audits Implantable Device Audits E&M Coding Audits Pharmacy Claims Audits Pre-Pay Audits Post-Pay Audits Desk and On-site Audits Fraud, Waste & Abuse Third Party Liability Pre-pay Subrogation: Subro-Accelerator Subrogation Solutions Coordination o Benefts About SCIO ® 3 4 - 5 6 - 7 8 -11 8 8 9 9 - 11 12 - 16 12 12 13 13 14 14 15 15 16 16 17 17 17 17 18 - 19 20 - 21 20 21 21 22 - 23 3 We no longer live in a pay-and-chase world. Highly successful companies are tapping into the art and science of technology and analytics to improve their payment integrity programs. Through a blend of pre-pay solutions, post-pay audits, payment analytics, clinical reviews and technology, SCIO® helps clients detect, prevent and recover more improper payments. Tay’ wr  Payt Itrity i yaic a rapiy cai. Tr ar w pprtiti t ptiiz ct ctait t a cit ar aci ay tratic qti, ici w t atat iparat prc, ipt w prra a rirt t, itrat ciica ata, icvr tciq t iprv ra a a tcti, a  ttr way t aa tip vr. Y  a tratic partr w i t  y acy  r tcy, a w i xi  t cr a itrat cpx ti t t yr payt itrity ca. We ARe TRAnsoRmIng PAYmenT InTegRITY. Aaytic ar at t cr  r rt capaiiti—wtr it i piticat arit t a pct cai a ii rrr, r v way t appy p kw  itry ci r a rati, w ar a t pt wak i payr yt a prc tat ctrit t rrr. or Payt Itrity ti  artr ta t—pi payr ai pr rtai  t ctiv  tir rt, a iprv t i way t r ty tay  t ctti . W p cit t  a tratic v a w a tacticay wit ay-t-ay ti. or xi at , t a prc ar i wit  a i i – r cit’ cc. Ratr ta ki at Payt Itrity a parat, iivia prra  t  capitaiz w p r cit trar t t ctti , t k at t i pictr a crat a ytic vra traty. sCIo ® ivr ti tat ar py iit a ttr at attacki tr ca  payt rrr a ty ccr a  r ii pricip: • Patr Vratiity • spiticat Aaytic • opratia exprti • Ciica Kw TAKe YouR PRogRAms Rom sPReAdsheeTs To VIsIbIlITY. or sCIomi™ Payt Patr ctai a it  appicati ici wrkw aat a rprti t tat ivr fcicy, xiiity a caaiity wit a ra ra  ivry  t t t   a a ar atcar raizati. Great Transformations Happen When Art and Science Collide. Master the Art & Science of Detecting & Preventing Improper Payments

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