- Map orders to payer-specific criteria
- Validate diagnosis, regimen, and planned services against policy
- Confirm whether clinical PA, drug PA, or both are required
Access Intelligence Hub
Front-Door Intelligence for a Clean, Confident Revenue Start
Most revenue problems start before the patient is even seen. SCIO’s Access Intelligence Hub is your front-door control layer — unifying Eligibility Intelligence and Authorization Intelligence to prevent avoidable denials, protect high-cost treatments, and keep schedules moving without financial surprises.
This is not just “eligibility & auth processing.” This is access decisioning — driven by automation, payer intelligence, and specialty-aware teams.
Eligibility Intelligence
Coverage Clarity Before the First Click of Charge Entry
Eligibility errors are still one of the biggest sources of avoidable write-offs in healthcare. SCIO’s Eligibility Intelligence turns what is usually a manual, fragmented process into a data-driven coverage engine tuned for oncology and multi-specialty groups.
What We Solve at the Front Door
- Missed or outdated coverage that leads to preventable denials
- Wrong plan, copay, deductible or out-of-pocket info given to patients
- Missed secondary/tertiary coverage and carve-outs
- Hidden prior authorization needs for high-cost drugs and procedures
How SCIO’s Eligibility Intelligence Works
Real-Time, Multi-Payer Coverage Sweep
Each patient is processed through an automated coverage sweep using:
- Payer APIs and clearinghouse integrations
- AI Agents for payer portals
- Rules for primary, secondary, tertiary, Medicare/Medicaid and carve-outs
The output is a complete coverage picture, not a basic “eligible / not eligible” flag.
Deep Benefit Intelligence for Complex Care
For oncology and high-acuity specialties, the engine performs:
- Medical vs. pharmacy benefit checks
- Benefit investigation using programs like Genentech / Amgen BI and other support hubs
- Frequency and coverage limit validation for regimens and high-cost drugs
- Identification of prior authorization requirements linked to specific drugs, CPTs, and diagnosis codes
Access Risk Signals & Alerts
Instead of just updating a spreadsheet, SCIO surfaces access risk signals directly into your workflow:
- Coverage gaps, terminations, and plan changes
- COB issues and missing secondary
- Benefit limits reached or close to threshold
- Referral / authorization requirements not yet satisfied
These are pushed to the practice before scheduling or charge capture, so the team can correct issues up front.
Technology Backbone
- AI Agent - Payer portal navigation
- API connectivity to 500+ payers for real-time data
- Automated COB and secondary/tertiary checks
- Demographic-based active coverage detection
- Eligibility and access dashboards at provider / location / payer level
What This Means for Your Revenue
- Eligibility-related denials driven down to near-negligible levels
- Fewer last-minute cancellations due to coverage surprises
- Higher first-pass payment rates with clean front-end data
- Clear, accurate patient responsibility at the time of scheduling or check-in
- Reduced back-office rework on “fixable upfront” issues
Authorization Intelligence
Prior Authorization That Keeps Up With Clinical Reality
Prior authorization is no longer a simple checkbox — it’s a moving target of payer rules, medical necessity criteria, and drug-specific policies. SCIO’s Authorization Intelligence is built to operate in this complexity, especially for oncology and procedure-heavy specialties.
From Manual Chase Work to Structured, Intelligent Flow
Instead of fragmented spreadsheets and ad-hoc follow up, SCIO runs a structured, intelligence-led flow:
Hybrid Submission Engine
- Use automation where payers support digital or portal submissions
- Layer expert, oncology-trained reviewers for complex or high-risk cases
- Standardize required documentation to avoid “missing info” pushbacks
Real-Time Tracking & Exception Handling
- Central worklist of all pending and expiring authorizations
- Proactive follow-up before service dates
- Confirm whether clinical PA, drug PA, or both are required
Seamless Handover to Clinical & Billing Teams
Once authorized, decisions and reference numbers are:
- Logged into EMR/PM
- Clearly tied to orders, diagnosis, and planned charges
- Available to coding, scheduling, and billing teams without extra calls or messages
What Makes SCIO’s Authorization Intelligence Different
Oncology-trained teams who understand regimens, NCCN pathways, NDC / J-code mapping, and high-cost drug risk
Policy-aware engine that keeps payer rules current and embedded into the workflow
Tight feedback loop between Authorization, Denials, and Decision Nest™, so every denial becomes learning data for future approvals
Impact on Operations & Revenue
With Authorization Intelligence in place, practices see:
- Consistent 3-day average turnaround for authorizations
- Substantial reduction in PA-driven denials
- Fewer rescheduled treatments and missed infusion slots
- Stronger protection of high-cost drug revenue
- More predictable reimbursement and smoother patient experience
Access Intelligence Hub: How It Feeds the Rest of Your RCM
The Access Intelligence Hub is designed to plug directly into the rest of SCIO’s ecosystem:
- Clean, verified eligibility and authorization data flows into coding, charge capture, and billing.
- Risk and exception signals feed into TrackAR™ for smarter AR follow-up.
- Denied or delayed cases become learning inputs for Decision Nest™ so future access decisions get smarter over time.
