Case Study: National Plans Data Mining Company achieves $13.5M in recoveries and 30–40% identification cost reduction with SCIO Health Analytics

National Plans Data Mining Company - Customer Case Study

National Plans Data Mining Company, representing three national plans covering over 14 million lives, needed to identify payment errors and recover overpayments while supplementing internal cost-containment resources. They required deep claims-audit expertise, sophisticated high-validation data mining that wouldn’t overlap existing efforts, and help identifying systemic issues; SCIO Health Analytics was engaged, bringing its SCIOMine™ proprietary data-mining and workflow management technology and a dedicated audit team.

SCIO Health Analytics implemented a dedicated claims-audit team, SCIOMine™ technology, contract reviews, and ongoing data exchange to efficiently extend the client’s cost-containment capability with minimal client resources. The work identified $13.5M and supported efforts that resulted in $125M in overpayment recoveries in one year, delivered average savings of $1.10 per claim reviewed, reduced identification costs by 30–40%, and helped the client fix recurring payment-process issues.