SKYGEN USA Companies

 

Technology Automation

Take control of your claims management costs.

Scion Dental

Enterprise Business Intelligence

Realize tremendous insight into your business with eBIS (Enterprise Business Intelligence System), Scion Dental’s paid-claim data warehouse and customized reporting capabilities. eBIS generates sophisticated, customized analysis reports through an easy-to-use web interface so managers can generate precise answers to complex questions.

eBIS generates thousands of reports from several types of standard report templates:

  • Profile Reports analyze a single subject according to predefined criteria.
  • Comparative Reports analyze two subjects according to predefined criteria. Comparative analysis can be one-to-one, one-to-many, or many-to-one. The basic report structure allows complete flexibility to select specific data elements for analysis.
  • Listing Reports analyze a single subject according to a variable number of user-defined criteria. Listing reports provide detail on any analytical field and can be used to create mailing lists and other correspondence.

We work closely with our clients to identify the most effective eBIS reporting tools for their business, and can generate additional customized reports as needed.

Executive Dashboard

Monitor your dental program in real time on a 24/7/365 basis with the Enterprise System’s Executive Dashboard. This web-based dashboard provides detailed statistics and comparisons in critical business areas, including:

  • Claim and authorization summaries
  • Member services metrics
  • Financial statistics and monitoring

With the Executive Dashboard, you can track operational activities and workflow efficiency, spot trends, and make informed business decisions faster based on real-time data.

Dental Specific Edits

We offer thousands of proprietary dental claim edits that can be applied during claims processing to verify beneficiary, provider and dental service eligibility. These pre-defined dental claim rules are based on Scion Dental’s extensive experience, industry best practices, licensed consultant reviews and past client input.

Proprietary edits can be customized with client-specific business rules to automatically determine authorizations, match authorizations against related claims for automatic consumptions, deny claims, and flag authorizations and claims with descriptive exception messages for further review.

The flexibility we’re able to provide clients is virtually unlimited. Any of these edits can be easily customized, turned on or off, automated or set up to require manual review, or applied selectively down to the level of an individual benefit plan, provider or clinic location.

Custom Web Portals

Scion Dental offers streamlined, paperless communication through secure, customized web portals for our clients, their members and providers. Individuals can easily access real-time data, including claim and authorization status information, at anytime from anywhere Internet connection is available. The portals can be branded to reflect clients’ logo and color scheme as part of Scion Dental’s ability to operate as an invisible partner. Our experience indicates that use of the web portals leads to faster turnaround times, lower administrative costs and increased efficiencies. We believe that adoption of web portals is the pathway to the future.

Our Branded Client Web Portal is the gateway to powerful oversight and management tools:

  • Manage claims and authorizations
  • Launch the Customer Service Module (CSM) to track and resolve customer inquiries
  • Launch the Authorization Determination Module (ADM) to determine authorizations and generate letters for providers and members
  • Launch the Enterprise Business Intelligence System (eBIS) to generate business reports
  • Launch the Executive Dashboard to monitor key business statistics

Our Branded Provider Web Portal is a powerful online tool that promotes improved member service and efficient claims processing through:

  • Claim management
  • Authorization management
  • Eligibility status inquiries
  • Benefit limitations
  • Data entry shortcuts
  • Report, document and file manipulation

Our Branded Member Web Portal offers unparalleled self-service options for:

  • Education - oral health materials
  • Servicing - locate a provider, verify eligibility, check claim history, check claim or authorization status and even issue a temporary ID card
  • Quality - Rate a participating provider and complete member surveys

Clinical Criteria

To ensure consistent and fair determination of coverage, Scion Dental has developed a set of more than 120 proprietary clinical algorithms, or decision trees that reflect clinical criteria. To provide a high level of customization, we can modify any of the algorithms, which cover more than 400 dental procedures, to meet each client’s requirements down to the individual plan level. Reviewed annually, these algorithms were created over ten years under the direction of Scion Dental’s Chief Dental Officer and a committee of independent dental consultants. We incorporated numerous sources of industry-standard clinical criteria, including:

  • Principles of diagnosis and treatment modalities taught in American dental schools and postgraduate dental programs 
  • Available evidence-based dentistry guidelines
  • State Medicaid guidelines
  • Educational literature and dental specialty guidelines published by various dental specialty organizations
  • Commercial dental benefit client criteria for decisions
  • The current Code of Dental Terminology (CDT) published by the American Dental Association (ADA).

Our clinical algorithms promote consistent utilization for clients, and help to prevent fraud and abuse. Clients appreciate the way they are integrated into our technology, which allows dental reviewers and dental consultants to quickly view the decision tree with a single click.  

Flexible Authorization Requirements

Our customizable system allows us to decrease administrative costs through the use of flexible authorization requirements. For providers or provider offices that routinely submit claims and authorization data which pass through the adjudication and determination process without exception, we’re able to relax authorization and documentation requirements. This may include removing the pre-authorization requirement on a number of dental codes or reducing the amount of required documentation providers must submit for service approval.  However, authorization requirements can be increased or re-imposed if providers’ practice patterns change. This targeted, individualized approach reduces costs for our clients and providers, and allows us to focus on providers with profiles and treatment patterns that warrant additional evaluation.

Authorization & Determination Logic

Our clear and consistent approach to authorization determinations promotes transparency, reduces administrative costs and delivers best-in-class turnaround times for authorizations. Scion Dental’s trained paraprofessionals and dental consultants utilize our customized clinical algorithms within a three-tiered method to ensure that all submitted authorizations are determined fairly, accurately, and consistently. These algorithms are available to providers through the Provider Portal so dentists can follow the decision matrix and understand the logic behind authorization decisions.

Customer Service Module

Our fully-integrated Customer Service Module (CSM) allows absolute, real-time transparency into all customer care interactions with members and providers. With it, we can achieve two important goals:

  • Provide customer service representatives with all tools necessary to resolve a caller's questions during the initial telephone communication. Representatives have instant access to a multitude of customer service tools, including claim history and payment information, authorization history, find a dentist, and more. Our representatives resolve more than 98% of member service communications on the first call.
  • Historical tracking of all calls. CSM maintains a call history for every member and provider in our system, recording and storing an audio transcript of all communications.

Scion Dental extends read-only user rights to our clients and their staff. Access affords your executive team the ability to monitor our performance regarding all member and provider interactions, in real time.

Implementation

Our Implementation Team ensures a smooth and successful transition for our clients, on schedule. We prepare a comprehensive project plan to manage all activities related to the transition. Once the implementation process begins, the plan is updated for weekly meetings with your team. We make extensive use of web-based meetings, both scheduled and ad hoc as a way to communicate and build our partnership to a high level of trust and confidence.

Implementation Team members are experts at establishing and maintaining electronic interfaces with a wide variety of vendors. We have a proven history of accurately converting full dental administration into our platform, on schedule.

Scion Dental, Inc.

N92 W14612 Anthony Avenue
Menomonee Falls, WI 53051-3140
877.724.6602
info@skygenusa.com

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