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How the 15-Minute IBill Audit Transforms the Payment Integrity Landscape

While the typical hospital claim review can take days to weeks – ClaimLogiq’s solutions empower analysts to finalize reviews in hours, even minutes. Now, ClaimLogiq has announced the 15-Minute IBill audit as part of our regular claim lifecycle audits.

The breakthrough 15-Minute IBill Audit is game-changing for payers of all shapes and sizes. Now, lengthy audits for complex hospital itemized bills, and unavoidable overpayments and recovery efforts, are a thing of the past.

The 15-minute hospital itemized bill review drastically impacts the healthcare payment integrity landscape with several transformative aspects:

  1. Fastest speed to pay
  2. Post-pay to pre-pay
  3. More reviews in less time
  4. Move PI Programs in-house
  5. Improved provider relations and patient experiences
  6. Revenue cycle
  7. Competitive offering for smaller Payers and TPAs 

Just because itemized bills can be complex doesn’t mean the audit process should have to be. TrueCost, ClaimLogiq’s cloud-based HITRUST CSF certified software platform, simplifies the claim review process and enables healthcare payers to find increased savings, improve user experience, make workflows more efficient, and have complete control over their claim reviews – with no sacrifice in accuracy or quality.

It’s all thanks to ClaimLogiq’s technology and simplified workflow that produces a complete end-to-end review ecosystem. Read about the 15-minute IBill Review end-to-end solution workflow here.

1. Achieving the fastest speed to pay

IBills are complex, and their complexity often leads to delayed payment timelines and longer reviews. These delayed payment timelines and missing the provider’s turnaround time window leads to penalties, late fees, and provider abrasion.

With TrueCost’s automated rules, routing, and ROCR, the most complex itemized bills can be completed faster, transforming the payment integrity landscape by moving payments to providers quicker to correct costs to patients and prioritize the health of provider relationships.

Want to see some examples of the 15-Minute IBill Audit in action? Read our 3-in-1 15-Minute IBill Audit Case Study.

It’s important to note that faster payment timelines are only as good as the accuracy of their solutions. The 15-Minute IBill Audit using ClaimLogiq software and technology produces the same repeatable, predictable, and consistent results without every compromising accuracy for the greatest cost savings and recovery.

2. Confidently moving Payers from post to pre-pay

Many payers don’t have the capabilities to move to pre-pay with in-house teams. Not to mention many vendor solutions often can’t complete accurate reviews for preferred TATs so payers are on the hook for potential penalties and fees with late payments. Manual systems and drawn-out adjudication timelines as a result of inefficient outsourced or in-house options lead many Payers to face payment integrity on a post-pay modality. Recovering savings on a retrospective basis versus avoiding costs prospectively increases provider abrasion and is a burden on resources throughout the healthcare revenue cycle. Not only that, to avoid penalties, payers completing post-pay recoveries means settling for less than up-front cost savings would have uncovered in many cases.

Outsourced solutions don’t have the capabilities for turnaround times like this, as they too are using applications that unnecessarily burden payment timelines. TrueCost changes that.

Moving from post-pay recovery to pre-payments avoids penalties and fees. Many payers assume pre-payments will take longer and extend the turnaround time – but with TrueCost, the opposite is true. The combination of CORRE and ROCR gets pay/pend decisions made and out the door in seconds so that payments can get to providers sooner and payers can move closer to auto adjudication of itemized bill reviews. The 15-Minute IBill moves payers from recovery to cost savings on the payment timeline spectrum.

3. More Reviews in Less Time

Our technology intelligently automates the IBill review process so that Payers can get correct payments out the door quicker.

CORRE and ROCR are both data agnostic and multi-threaded, taking in any type of file or size and rapidly matching against Payer customized rules and normalizing data in milliseconds to minutes.

This gets more IBills into TrueCost faster for faster more reviews in less time.

Now, you can get multiple IBills reviewed in the time it previously took you to review one. With no compromise in accuracy or consistency, Payers can increase the volume of itemized bills that can be reviewed and find further savings and revenue through an increase in capacity.

4. Gives Payers the option to move from Services to SaaS

Historically, Payers have been stuck between a rock and a hard place — spend days to weeks analyzing claims, or forfeit transparency and control over the process by outsourcing their payment integrity efforts to an expensive vendor who isn’t much more efficient.

Payers no longer have to outsource to inefficient, costly vendors, when they can confidently bring complex bill audits in-house using ClaimLogiq’s SaaS solutions. ClaimLogiq provides Payers options and choice: claim review services are fully transparent, Payer-controlled, and customizable, while our cloud-based TrueCost platform can also be purchased as a SaaS and used in-house by a Payer’s existing payment integrity program or auditing team (even if working remotely!) The platform is intuitively designed and makes any reviewer an expert regardless of experience level — plus, our team is just a phone call away, ready to assist whenever the situation calls for it.

Read the white paper on how to bring payment integrity programs in-house with TrueCost.

5. Improved provider relations and patient experiences

Overpayments to providers lead to chasing down providers for corrections. But when providers aren’t chased for overpayment recovery and payers instead complete complex audits and moving the payment timeline as far left as possible, it minimizes provider abrasion to keep provider relationships strong.

ROCR helps move towards pre-payments with a proactive approach – so that payers can correct funds upfront the first time.

Because ROCR can automatically read lower-quality templates, chances of a re-request are lower, which reduces touches and lowers provider abrasion.

Even if there is an agreement to complete audits only in post-pay, should a provider agreement require it, TrueCost still shortens the recovery timeline. Our 15-Minute IBill Audit reduces the time required to get to a recovery request once payment has already been posted.

Because this speed doesn’t impact ClaimLogiq’s hallmark accuracy and consistency, providers more and more confidence in results over time, lowering appeals and overturns.

When providers can get paid quicker, the entire payment integrity landscape is affected and everyone is happier. Patients receive correct bills in a timely fashion. Costs become more predictable, with cost inaccuracies removed faster. Patients can have further control over the cost of their healthcare.

6. Transforming the revenue cycle

As automation increases and this technology becomes stronger, patients, providers, payers, and the entire healthcare ecosystem will see near real-time processing for almost instant payments.

Payments can be made closer to actual transition time, whether pre-pay or post-pay if required by provider agreements. With pre-payments, payers save, and providers receive payments faster – and even post-pay, overpayment recovery can happen right after the payment is made, without any further delay.

7. Smaller Payers and Third Party Administrators can get started fast with large claims

Smaller payers tend to stay away from large, complex IBill reviews due to a lack of resources to review them efficiently. When reviews are completed, often only a sample size of claims is selected for review, leaving potential valuable cost savings on the table.

These payers often don’t have the resources or capacity to audit large claims. They avoid doing them in-house due to cost, resources, or the sheer amount of time it would take to complete for accurate and adequate savings. It can be highly impractical for these plans to do thorough audits both in-house and outsourced. Similarly outsourcing these hospital claim reviews can become costly and unnecessarily lengthen payment timelines forcing many to act retrospectively, versus prospectively.

But these smaller payers and TPAs because of these barriers to entry, who have been unable to efficiently review in-house or confidently use an outsource solution can now close the gap and analyze larger, more complex IBill reviews with TrueCost!  Go beyond selecting small sample sizes of claims,move to pre-pay, prove TAT and meet SLAs with 100% of claims reviewed with the 15-minute IBill audit solution.

The 15-Minute IBill Audit enables small payers and TPAs to add more complex audits to their payment integrity lifecycle, begin PI programs, and begin active cost avoidance programs.

These payers can start auditing these complex bills in their preferred method – whether using TrueCost as a SaaS, Services, or a hybrid model, and whether pre-pay or post-pay – while never holding up timelines for their clients or employer groups.

Showing tangible cost savings to clients, and demonstrating the ability to complete these complex audits to avoid unnecessary costs or recover savings to keep plan costs lower, are essential. Utilizing the 15-Minute IBill Audit can increase loyalty and retention and serve as a key competitive tool to have in payers’ toolbelts to remain competitive in the healthcare insurer marketplace.

The healthcare ecosystem needs quick, reliable, and accurate claim reviews.

Cost avoidance on a proactive basis means that fewer false funds are not just benefiting the payment integrity space but flowing through the entire healthcare system.

Patients are receiving correct costs and correct bills for their healthcare, as providers are receiving faster payments readily available to inject back into the care of patients.

Providers have more confidence in costs upfront with repeated accuracy and consistency, leading to even lower appeal rates and, therefore, lower overturns. Provider abrasion is reduced, with no more strain on collecting recoveries.

Payers offer comprehensive, quality, and affordable healthcare options to patients while remaining competitive in the marketplace and improving relationships with providers.

Complex problems can’t have complex solutions – they need logical ones. Now, the 15-Minute IBill Audit is closing this gap in the payment integrity space so that payers of all sizes and scopes don’t have to choose between forfeiting business on complicated reviews or devastating their turnaround time and relationships with their clients by performing the review with inadequate resources.

TrueCost and ROCR aren’t done yet, either. They are learning tools and evolve with payment integrity program needs and industry demands over time. They automate more and more over time while never losing the element of the discerning human eye.  ClaimLogiq will continue to refine the technology and grow its sophistication – always ahead of the curve, serving the entire payment integrity ecosystem.

Download our 15-Minute IBill Audit 3-in-1 Case Study to see real examples of TrueCost in action, with varying size and scope of projects.

Curious to learn more? Get in touch with our team any time to see how TrueCost can help your Plan get healthcare claim reviews done in minutes.