Our Claims Management Services
SCIOinspire's comprehensive claims management solution provides services including Benefit Plan Coding/Creation, Claims Pre-Processing/Entry, Claims Adjudication, Claims Quality Control, and Claims Audit. We manage the full spectrum of sub-processes, including determining eligibility and validity of submitted claims, checking for covered services, and performing the adjudication process. The solution will also establish liabilities of members, healthcare organizations, and third parties, and can verify and generate authorizations for referrals from PCPs to specialists.
Client Pain Points
- Rising healthcare costs
- Need to concentrate resources on critical tasks
- Need to maintain a range of analysts, staff, and resources
- Hourly payment model
- Management talent tied to claims process
- Accumulation of redundant information in multiple locations
- Inefficient data management and processes
- Claims process dependent on timely availability of documents
- Need for increased resources during enrollment spikes
Our Value Proposition
Create more value for your shareholders and clients by partnering with SCIOinspire. We provide a robust end-to-end technology solution for managing claims, so you can replace your recurring fixed costs with performance-based payouts. Our streamlined workflow platform will produce the following benefits for your organization:
- Streamlined enrollment capture process
- Tracking of all submitted records
- Significant reduction in recurring costs
- Improved use of management talent
- Claims processes administered by experts
- Better accountability through document tracking
