Case Study: Large Regional Blues Plan Provider achieves $12M+ in overpayment prevention with SCIO Health Analytics

Large Regional Blues Plan Provider - Customer Case Study

Large Regional Blues Plan Provider engaged SCIO Health Analytics to apply prevention analytics and industry expertise to identify where overpayments could be prevented. The client faced complex, recurring payment errors driven by varied payment policies, provider contracts and regulations, and lacked internal resources that combined deep subject-matter knowledge with robust analytics.

SCIO Health Analytics applied complex analytics to flag unusual payment patterns, then used subject-matter experts to review claims configuration, adjudication and contract interpretation and recommend preventable fixes. In the first six months SCIO identified at least four systemic overpayment issues with a combined opportunity exceeding $12 million (including a $2 million overpayment from an outdated radiology drug fee schedule), helped establish leadership-level prevention processes, and delivered the work at roughly 50% of the client’s expected cost.