Contact: Elizabeth Glaser
Dodge Communications
770-576-2551
eglaser@dodgecommunications.com
SCIOinspire Launches Claim Audit and Recovery Division
Acquisition of WayMark Associates expands offerings to help healthcare payers identify, recover and reduce improper claim payments for specialty pharmaceuticals, implantable devices, E&M services
Hartford, CT - Sept. 15, 2009 - SCIOinspire, Corp., a premier provider of analytics-driven business process solutions to health plans and hospitals, today announced the launch of its Claim Audit and Recovery business unit with the acquisition of WayMark Associates. WayMark is an industry leader in assisting healthcare payers to identify and recover improper claim payments. Its unique offerings currently include audit programs related to the accurate billing and reimbursement of high-cost specialty pharmaceuticals and implantable devices, as well as E/M coding evaluation.
Payer organizations today are turning their attention to overpayments for specialty pharmaceuticals in particular, because expenditures are rising rapidly. The healthcare industry expects to spend almost $100 billion annually in specialty pharmaceuticals by 2010 - compared to only $2 billion in 2001 - with 12-15% annual growth forecast for subsequent years. Use of implantable devices similarly is growing at a tremendous rate, expected to reach $37 billion in sales by 2013. Additional information on the topic is available in the SCIOinspire Specialty Pharmaceuticals White Paper.
WayMark Associates was established in 2006 by four principals with extensive claims cost-containment experience working for large, national health plans: Steve Palma, Rodger F. Smith, Jr., Nicola S. Coleman and Lou Gianquinto, Jr. In addition to developing and running successful generalized claim overpayment recovery and prevention programs, the team specialized in select areas of claims payment that often have a disproportionately adverse effect on payers’ efforts to manage costs.
WayMark Associates’ outstanding reputation and proven success will catalyze SCIOinspire efforts to help healthcare payers avoid improper reimbursements and, consequently, reduce overall healthcare costs. "Billions of precious healthcare dollars are being wasted due to inefficient payment processes and overpayments," says Siva Namasivayam, Chief Executive Officer for SCIOinspire. "Waste of this magnitude is always of great concern. But it is even more significant now, as health plans from coast to coast are striving to trim unnecessary costs from the healthcare system.
"It’s critical that payers have access to services, analytical tools and technology to counter this growing concern. WayMark Associates brings a wealth of experience with payer organizations. We are confident that our joint expertise will deliver highly effective solutions," he adds.
Steve Palma, a co-founder and principal of WayMark Associates, is a Senior Vice President in SCIOinspire’s new Claim Audit and Recovery division. He notes it isn’t surprising that claim overpayments are occurring so frequently. "The complexity of the industry’s various, often conflicting claims billing and processing rules, coupled with aging claims adjudication systems, are fueling this alarming increase."
He adds that leadership at WayMark Associates - serving major payers across multiple service lines with millions of covered lives - recognized integration with SCIOinspire as a tremendous opportunity. "We are joining with a growing and innovative company that offers major technology resources and significant expertise in data analytics," he says. "This move allows us to deliver an even better product to our clients".
The new Claim Audit and Recovery business unit will complement current SCIOinspire programs in Care Management, which focuses on applying predictive modeling and analytics to improve program design and execution, as well as Subrogation and COB, which identify potential other-party coverage liability, accelerate overpayment recovery and deliver analytic rules to minimize future exposure.
"We are excited about this next phase of our growth," adds Namasivayam. "Adding claim audit and overpayment recovery functionality to SCIOinspire’s array of services represents a powerful solution that will deliver more value to our clients - assisting them in better managing their costs and revenue streams."
About SCIOinspire
SCIOinspire provides analytics-driven business process solutions to the health plans and hospitals, enabling the healthcare community to achieve measurable outcomes, cost savings and increased revenues. Offerings include care analytics, third-party liability recovery, claim audit and overpayment services, data management, care management evaluation and support, and actuarial services. SCIOinspire collaborates with clients through a unique delivery model that includes strategic consulting, analytics support, software-as-a-service technology platforms, and business process outsourcing and cosourcing. To optimize cost-management outcomes for clients, SCIOinspire draws upon an expert team of clinical, actuarial, legal and analytical resources, complemented by technology and knowledge assets. Additional information about overpayment recovery strategies is available in the SCIOinspire Specialty Pharmaceuticals White Paper.
