Industry studies estimate that payers could be losing in excess of $100B annually to financial leakage. Recognizing the active dynamics of the healthcare industry, SCIOinspire has developed a strategy and solution to help Payers identify and reimburse incorrectly paid claims. SCIOinspire offers proprietary technology platforms that have been developed by subject matter specialists with vast experience in the healthcare domain. Our MY SERIES suite of applications includes MY SOCRATES® (Our Subrogation technology platform) and MY COB™ (Our Coordination of Benefits platform).

Value Proposition

  • Perform end-to-end TPL recovery process in a complete paperless environment
  • Support flexible delivery models and rapid implementation time: hosted and client server models
  • Provide advanced document management capabilities
  • Automated tracking systems that can seamlessly integrate existing client’s mail rooms, claims systems and call center facility
  • Advanced data mining capabilities with predictive modeling logic to accurately identify and recover claims
  • Applications embedded with ICD, CPT codes, CMS guidelines, State and Federal laws
  • Maintains a complete audit trail of case activity and is compliant with the Health Insurance Portability and Accountability Act (HIPAA)
  • Transparent, real time, and 24 X 7 access to reports and case management through our secure online portal

SCIOinspire offers the following proprietary software applications in Payment Integrity areas:

MY SOCRATES®

MY SOCRATES is a customizable, paperless subrogation case management software that offers a stand-alone subrogation solution from Identification to Investigation, Case Management, and Recovery/Credit. Our application supports recovery of both Medical (Dx) and Pharmacy (Rx) claims by intelligently mapping both Dx and Rx claims to cases.

MY COB™

SCIOinspire’s MY COB is an Identification and Case Management Application that enables health plans to manage, from end-to-end, the entire COB identification, prevention, and recovery process. In parallel, it builds comprehensive databases to prevent future incorrect provider reimbursements. Its robust workflow and flexible rule-based engine derives logic from regulatory state-specific NAIC, CMS standard, and Medicare guidelines to achieve this goal. Additionally, the application accurately identifies primary and secondary responsible parties in any health plan (commercial/Medicare).

Ted Hedrick
President, Claims Audit & Recovery

Rob Martin
Executive Vice President & Chief Operating Officer, Claims Audit & Recovery

Brendon Tucker
Senior Vice President, OPL Services

Phyllis Baum
Senior Vice President, Clinical Operations

Rena Bielinski
Senior Vice President, Pharmacy & Ancillary Operations

Sharon Houlihan
Chief Clinical Officer

Arun Rangamani
Vice President, Process & Technology, SAS 70 & Information Security

Tom Cummings
Chief Information and Security Officer

What Would You Like To Do?
MY SOCRATES®

Discusses the challenges of subrogation faced by clients on the field and how MY SOCRATES unchecks these challenges.

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