Payment Integrity

SCIOInspire, Corp.

Payment Integrity

A full cycle approach to claims auditing, by focusing on prevention, avoidance and recovery

Claims Management Claims Management Solutions Physician Practice Management

Do you know anyone using Payment Integrity?

SCIO’s Payment Integrity Solutions help Payers, Health Plans, and PBMs control costs associated with third-party liability and incorrectly billed or overpaid health claims to reduce overall health claim expenditures. Our products and services target other party liability, fraud, waste, and abuse via a complete line of subrogation, claim audit and overpayment programs, and data mining solutions.

Services:

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.

Pharmacy Claims Auditing:

Our pharmacy claims auditing services focus on pharmacy compliance, overpayment identification, and fraud.

Our Claims Audit Capabilities Include:

  • Data Mining
  • Contract Review
  • Payment Policy Review
  • Clinical Review
  • Fraud, Waste and Abuse Review
  • Other Party Liability and Subrogation Review
Payment Integrity

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