Facility audits by SCIO Health Analytics

Level I facility audits

SCIO Health Analytics attempts to schedule an exit conference with each facility after an audit is complete. If an exit conference is not possible at the time of the audit, SCIO tries to schedule one with the facility within 30 days of the audit.

Disputing the findings

Each facility may review and agree with the findings, or review and dispute the findings. Disputes must be based on medical record and/or source documentation.

Undisputed findings

If SCIO is unable to schedule an exit interview and the facility has not attempted to dispute the audit, the audit results are sent to Priority Health for processing.

Level II facility audits

If you have exhausted the SCIO process and you still disagree with the findings, submit your dispute to the Priority Health Special Investigations Unit within 45 days of receipt of SCIOs response.

Documentation

Include the following information:

  • Copies of the initial audit findings, your appeal letter and the SCIO response if available
  • Documentation/summary of why you disagree with the findings and/or interpretation of a guideline
  • Pertinent pieces of the medical record that support your dispute (NOT the complete medical record)
  • Query documentation if appropriate
  • References that support your dispute

Submitting your dispute

Send your dispute to Priority Health at:

Fax: 616.942.7916

Mail: Priority Health
Attn: SIU MS 3175
1231 E. Beltline NE
Grand Rapids, MI 49525

Email: SIU@priorityhealth.com