Medical & Pharmacy Claims Auditing

SCIOnspire, Corp.

Medical & Pharmacy Claims Auditing

Reduce overall facility adjudication reimbursement expenditures and minimize pharmacy abrasion

#medicalbilling Coding / Billing And Claims

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For over 14 years, SCIO® has partnered with Payers, Health Plans, and PBMs to optimize reimbursement. Through a blend of audit services, workflow technology, payment analytics, and clinical reviews, we help clients detect, prevent, and recover improper payments across the payment lifecycle. Clients benefit from our platform versatility, sophisticated analytics, operational expertise, and clinical knowledge.

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. We perform both on-site, and desk audits for various types of medical claims, including:

  • Inpatient claims ( DRG, % Charge, Short Stay)
  • Outpatient claims (APC)
  • Ancillary facility claims ( SNF, Home Health, DME, High-Cost Drug)
  • Professional claims (E&M Coding)
  • Other Party Liability ( Subrogation)
  • Fraud Waste and Abuse (SIU Models)
Medical & Pharmacy Claims Auditing