Better review consistency.
Improved payment integrity.
Stop reacting to the unexpected.
Anticipate & adjust.
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.
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.
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.
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.
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.
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.
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.
Having all the tools needed to conduct large claim reviews in one application increases production and is essential to meeting production goals.
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.
Workflow management is an imperative component to a claim review department. But without the proper systems, it is impossible to do this effectively.
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:
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Claimlogiq takes privacy and information security very seriously. We are compliant with the regulations and conditions set forth in the Health Insurance Portability and Availability Act of 1996 (HIPAA). Claimlogiq, defined as ‘Business Associate” per the HIPAA act, shares a commitment with HIPAA Covered Entities to protect the privacy and confidentiality of the covered information obtained; subject to the terms of a Business Associate Agreement. Claimlogiq has implemented administrative, physical, and technical safeguards that protect the confidentiality, integrity, and availability of covered information that is received, maintained, or transmitted on behalf of the HIPAA Covered Entity.
ClaimLogiq’s TrueCost SaaS platform is certified by the Health Information Trust (HITRUST) Alliance. The comprehensive HITRUST CSF information security framework incorporates healthcare specific security, privacy, and regulatory requirements to include HIPAA, NIST, ISO, and COBIT, as well as industry best practices to provide a single evaluation framework designed to support the information protection needs of ClaimLogiq’s clients.
“The HITRUST CSF is the gold-standard that needs to be met and we are pleased to be able to achieve this certification, showing our commitment to the information security of our clients and the healthcare industry.”