WEST HARTFORD, Conn., Nov. 1, 2016 /PRNewswire/ -- SCIO Health Analytics today announced that it added or expanded business with several national health plans for its reimbursement optimization line of business in the third quarter of 2016. The client wins, which encompass the company's Medicare, Medicaid and commercial lines of business, increase SCIO's market share in auditing programs for cost containment and payment integrity by an additional 7 million covered lives.
The new and expanded partnerships for payers and PBMs span SCIO's entire suite of payment integrity and cost containment analytics and audit services, which take a "full cycle" approach that focuses on prevention, avoidance and recovery. SCIO provides clinical audit reviews to help uncover billing and payment errors, enabling payers to recover costs, predict patterns to monitor billing and reduce fraud, waste and abuse, and prevent future billing errors.
As healthcare transitions to a value-based reimbursement model, payment integrity is under greater scrutiny than ever as a result of revenue concerns among payers, PBMs and providers. Bundled payments and other shared-risk programs create the potential for a profound financial impact that increases the importance of ensuring accuracy throughout the revenue cycle. SCIO's analytics and auditing services deliver tighter control over the entire process, helping payers and providers weather the current financial storm while preparing them for the value-based care and reimbursement model that is now emerging.
Although cost containment is the primary focus, SCIO's approach is also sensitive to helping payers avoid negatively affecting providers. Through high accuracy rates, precision selection as well as prediction and early identification of billing outliers, SCIO helps payers avoid provider abrasion.
"With the financial future of the healthcare industry in so much flux right now, payment integrity and cost containment have become critically important," said Krishna Kottapalli, chief growth officer and co-founder at SCIO Health Analytics. "As new payment models are introduced, having systems in place that can manage them effectively will become a difference-maker. SCIO's reimbursement optimization solution for payment integrity has proven that it can improve billing accuracy and scale to the needs of even the largest payers. We are proud that these clients have chosen to partner and expand their relationship with us."
About SCIO Health Analytics
Based in West Hartford, Connecticut, SCIO Health Analytics is a leading health analytics solution and services company. It serves healthcare organizations across the continuum including over 20 provider groups and 30 health plans representing more than 90 million members, four of the top six PBMs, and clients in 30 countries for 8 of the top 15 global pharmaceutical companies. SCIO provides predictive analytic solutions and services that transform data into actionable insights, helping healthcare organizations create the understanding that drives change through care, network and reimbursement optimization as well as commercial effectiveness. SCIO's insights as a service approach supports the shift to value-based care, solving healthcare problems simply and efficiently. Visit SCIO's new website for up to date information on their product and solution offerings: www.sciohealthanalytics.com
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SOURCE SCIO Health Analytics