The SCIOinspire Corp., a provider of analytics-driven business process solutions for health plans and hospitals, has acquired National Audit, a healthcare claims audit and payment integrity services provider to large commercial and Medicare and Medicaid payers and pharmacy benefit managers.
[See also: Study says Medicaid could save $30 billion in pharmacy benefits.]
SCIOinspire is known in the industry for its technology and service offerings in the areas of care and wellness management, care analytics and data mining, payment integrity and business process optimization.
Company officials say the acquisition of National Audit will augment SCIOinspire's existing administrative expertise with a seasoned clinical perspective into the complexities of healthcare claims auditing. With these additional capabilities, SCIOinspire can provide a full view of MLR and ALR improvements to its clients and offer a flexible approach consisting of advisory, technology, compliance audit, pre-payment, co-sourcing and full-outsourcing options.
Officials say the combined assets will enable SCIOinspire to deliver an end-to-end suite of solutions that address the full spectrum of reimbursement challenges facing health plans and providers, including tools to:
- help detect and prevent payment errors;
- ensure submitted claims comply with payment policies;
- optimize reimbursement processes for timely, accurate payment; and
- prepare for the emergence of new reimbursement models such as accountable care organizations.
[See also: Experts predict top 10 payer trends for 2010.]
"The clinical resources that National Audit brings to SCIOinspire are second to none," said Siva Namasivayam, the CEO of Hartford, Conn.-based SCIOinspire. "National Audit exhibits unsurpassed expertise in all hospital- and payer-related reimbursement methods and brings deep insight into specific high-cost areas across treatment settings such as hospital, pharmacy and skilled nursing facilities – all of which are recognized as vulnerable to payment issues."
He added that "these attributes, combined with a well deserved reputation for superior service delivery and quality, illustrate that National Audit is the ideal complement to SCIOinspire's analytics-driven cost management technologies and services."
National Audit executives have accepted senior executive positions with SCIOinspire to ensure a smooth transition and position the company for continued growth. National Audit was advised by Technology Holdings in the acquisition.
"We are excited about the opportunities that lie before us," said David Hedrick, CEO of National Audit. "We are confident that our personnel will contribute significant value to SCIOinspire and are delighted with the expanded offerings now available to National Audit clients. We anticipate that the healthcare community will benefit greatly from this combination of leading-edge technologies and proven audit services – offering health plans a holistic look at payment integrity from both a clinical and administrative perspective."