Case Study: Medicare Advantage Health Plan (Central US) recovers $7M in CMS reimbursement with SCIO Health Analytics' SCIORevMaxPro

Health Plan Provider - Customer Case Study

Health Plan Provider, a Medicare Advantage plan with over 50,000 members and contracts across multiple medical groups, faced gaps in transparency and collaboration with its provider network that put CMS risk‑adjusted reimbursement at risk. With internal IT resources committed elsewhere, the Health Plan Provider engaged SCIO Health Analytics and its SCIORevMaxPro SaaS to provide subject‑matter expertise and tools to help physicians improve documentation, coding, and visibility into CMS submissions.

SCIO Health Analytics implemented SCIORevMaxPro to deliver near‑real‑time, actionable visibility of what CMS had accepted, allowing providers and the Health Plan Provider to “read from the same page,” identify missing diagnoses, and act before submission cutoffs. The work uncovered a broken automated feed; after the plan corrected the process, the Health Plan Provider recovered about $7 million in additional reimbursement and strengthened provider engagement in the risk‑adjustment process.