Industry studies estimate that payers could be losing in excess of $100B annually to financial leakage. We provide comprehensive programs that help health plans control fraud, waste and abuse via a complete line of subrogation, coordination of benefits (COB), claim audit and overpayment programs, and data mining solutions. In addition to providing a suite of services we also provide clients with advanced technology platforms for subrogation and coordination of benefits.
Value Proposition
Billing and Reimbursement Validation Services
SCIOinspire provide the most comprehensive claim audit and overpayment programs to help payers address financial leakage. We are unique as we leverage both data mining and extensive manual clinical review capabilities to drive our programs. We helps clients comprehensively address overpayments and have built leading programs for all reimbursement methodologies.
Third-party Liability
We offer two programs in the areas of TPL/OPL:
Subrogation Services
SCIOinspire offers clients flexible subrogation services that leverage our deep expertise, unique delivery models, and proprietary software. We work with clients to determine the best way to address TPL/OPL.
Coordination of Benefits Services
SCIOinspire uses a pragmatic approach to holistically address COB/Eligibility related overpayments with both short-term and mid-term solutions. Our short-term solutions address the areas of overpayment identification and recovery (retro-term, group-term, COB adjudication, other carrier, student age etc.). Additionally, our mid-term solutions help to fix COB/Eligibility data by utilizing targeted and innovative point solutions.
