Few issues challenge commercial health payers more than cost management, especially during the times of great change. They must continually strive to balance their mandate to provide coverage and reimbursement for the overall health of the population against their corporate mission to optimize resources and preserve financial viability.

SCIOinspire offers flexible delivery models including software applications, outsourcing (on-shore and off-shore) and co-sourcing.

Pain Points

Commercial plans are concerned with:

  • Spiraling cost of covering medical services for members
  • Demonstrating value of care management programs
  • Assigning appropriate resources to care management
  • Financial "erosion" via third-party liability and COB claims
  • Claim overpayments and recovery
  • Improving efficiency of business processes

Value Proposition

SCIOinspire solutions enable commercial plans to:

  • Improve segmentation, management of members for care management
  • Prove ROI via analytics and custom reporting
  • Increase recovery dollars through better identification and investigation techniques
  • Multiple, flexible workflow and process improvement technologies and services
  • Deep domain expertise, singular focus on healthcare payer

SCIOinspire Offerings

SCIOinspire is committed to helping commercial payers large and small in three distinct areas:

Improving both the effectiveness and efficiency of care management programs. Recognized as outstanding tools to improve the health of the American population, these initiatives also carry a substantial price tag - making it imperative for payers to design, develop and deliver care management programs that meet measurable objectives. SCIOinspire offers end-to-end analytics-driven solutions

  • Outcomes Analytics
  • Consumer and Patient Engagement
  • Wellness and Gaps in Care Alerts
  • Data Integration and Reporting
  • Health Economics Modeling

Identifying revenue opportunities and preventing revenue erosion. In the course of processing claims, commercial payers must balance the need to satisfy timely payment requirements ensuring that they reimburse claims only when appropriate and for contracted amounts.

  • Subrogation
  • COB
  • Advanced MY Series applications
  • Workers’ Compensation
  • Audit and Recovery (high-cost specialty pharmaceuticals, implantable devices, E&M coding)

Facilitating business process improvement throughout the enterprise. SCIOinspire offers an extensive menu of customizable solutions, offered through flexible delivery models.

  • Consulting services
  • Analytics and Data Management
  • Actuarial and Underwriting Support