What if...

What if outsourcing could be eliminated?

Improved turnaround.
Better review consistency.
Fewer appeals.

What if more reviews were possible with fewer resources?

Improved payment integrity.
Reduced overpayments.
Better ROI.

What if a single platform could manage your entire audit process?

Stop reacting to the unexpected.
Anticipate & adjust.
Real-time metrics.

Solutions

The Large Claim Review Process – Simplified

Our mission is simple:
Help payers improve their large claim review outcomes by providing tools to simplify and take control of the process.

TrueCost Claim Analyzer

A Claim Review & Workflow Management Platform

They are your claims and your provider relationships – protect them.

ClaimLogiq’s TrueCost platform is a cloud-hosted facility claim auditing solution designed to streamline payers’ internal large claim reviews. TrueCost is the only platform of its kind that offers payer organizations complete control over their claim auditing programs.

The "Black Box" Effect
Historically, outsourcing large claim reviews means giving up control of critical decisions in the audit process. Contrary to sending your claims into a “black box” of unknown prescreen rules and edits, TrueCost provides complete transparency and control over audit rules and processes. Additionally, built-in analytics put you in a much better position to anticipate and adjust to the landscape rather than reacting to the unexpected.

Highlights:

  • Automated itemized bill editing
  • DRG validation auditing
  • Completely paperless environment
  • Increased review capacity by 3 to 4 times without increasing resources
  • Completely transparent rules, edits and denials that are customizable by plan and provider
  • Algorithms that learn provider-specific denials which are utilized on future cases
  • Cross-claim validation ensuring agreement between professional and institutional claims
  • Medical records attached to cases which support clinical determinations and outcomes
back
mouse

Itemized Bill Reviews

TrueCost’s itemized bill review capabilities include automated itemized bill editing, customizable denial libraries, and feature-rich review functionality that improves the i-bill review speed and accuracy across all team members.

Highlights:

  • Automatically identified denials that are presented to the user for validation
  • Consistent itemized bill views regardless of the provider billing format
  • Denial libraries that are customizable by provider
  • Consistent denials which reduce provider appeals over time
  • “Learning” platform in which the system remembers denials that are unique to provider billing patterns
  • Robust search and filter functionality allowing users to quickly identify items across many pages of itemized bill records
back

DRG Validation

TrueCost’s DRG validation tool offers your analysts prescreen rules designed to select the claims best suited to payer’s unique review programs. These rules are tailored to fit the specific needs of your provider contracts and plan designs.

After the prescreen selection process, claims are then routed to the appropriate queues that match cases to the best suited analyst. As necessary, cases (including all documentation) are routed to medical director level for final review or approval. All of this happens in a paperless environment, and is done seamlessly regardless of the user’s physical location.

Highlights:

  • Standard or customizable prescreen rules for DRG validation section
  • Workflow controls that route claims to the appropriate team member
  • Built-in DRG calculation for every claim
  • Consistent denials which reduce provider appeals over time
  • OCR’d Medical records attached to each case streamlining DRG validation
  • Clinical rationale drives to reporting as well as provider correspondence
back

Claim Review Outsourcing

TrueCost’s completely paperless environment allows for easy workflow management and collaboration on claims, regardless of users’ physical work space. Payers can utilize the platform to review claims internally or, when needed, route cases seamlessly to ClaimLogiq’s review staff for external review.

Routing decisions can be managed by pre-defined rules, or cases can be routed to ClaimLogiq reviewer staff as needed in high volume situations or special situations.

Highlights:

  • Ability to flex claim volume without increasing internal staff
  • Seamlessly send specialize or seldom-encountered cases to ClaimLogiq as needed
  • Because reviews are {guided / driven} by pre-established rules and protocols, the TrueCost platform keeps payers and ClaimLogiq staff aligned
back
Claim Review Outsourcing

Transparent

Large claim reviews are critical to controlling costs and maintaining payment integrity. But lack of transparency makes reviews difficult if not impossible without the right tools.

Efficient

The large claim review process is resource-intensive, manual, subjective, and time-consuming – taking several hours or even days to complete. Our platform reduces that time to minutes.

Empowering

Any payer's largest segment of healthcare payments are facility claims. ClaimLogiq’s technology platform provides a means to finally gain control of your internal review department.

The need for a better solution is clear. Take control.


Improved Productivity

Having all the tools needed to conduct large claim reviews in one application increases production and is essential to meeting production goals.

  • System access anywhere providing the ability for team member to work in different locations or telecommute
  • Instant team collaboration whether colleagues are in the next room or in the next state
  • Centralized audit documentation means reviewers are up to speed on a claim review - no matter when it was last touched

Better Audit Tools and Resources

In order to meet productivity goals, auditors need the ability to work more efficiently - they need to have better audit tools and resources in a single platform.

  • Users are presented with tools that speed up the review process
  • The application has in-line tools and resources which eliminate the need to access multiple systems
  • Payers have the ability to turn on automated reviews
  • System includes large claim editing tools including UB04 edits, itemized bill edits, DRG, OCE editing, and more

Workflow Management

Workflow management is an imperative component to a claim review department. But without the proper systems, it is impossible to do this effectively.

  • Audit-specific forms (DRG, MD prep forms, Provider correspondence forms, custom forms, etc.)
  • Management tools that provide departmental results in real-time
  • Audit-specific workflows that help improve review consistency among audit staff

About Us

In 2001, Todd and Janene Hill established a claim auditing company called ARC Review Services. As that company grew, they came to understand the need for a better claim auditing solution, and in 2013 ClaimLogiq was created to answer the challenge.

Our proprietary applications have been developed to:
  • Make an extremely complicated process much more manageable
  • Solve the problems of consistency and accuracy
  • Control the operational costs associated with the claim audit process
Bottom line – we are in business to simplify your large claim auditing process.

ClaimLogiq


1156 Bowman Road Suite 200
Mount Pleasant, SC 29464

P: (678) 585-9903
info@claimlogiq.com