Reasons Payers Should Evaluate Bringing Payment Integrity Programs In-House

In the world of healthcare, claims audits can be complicated. It’s no wonder most healthcare plans that don’t have the bandwidth to spend days analyzing stacks of paperwork opt to outsource their claim reviews to third-party vendors in order to alleviate the burden.

While outsourcing claim auditing responsibilities to another vendor may seem like the quickest and simplest way to free up your team, with most vendors, it also means you typically lose transparency into the review process. You also typically lose the ability to customize claim rules for each provider, and ultimately, control over claim reviews as a whole, leaving potential savings on the table and provider relationships mismanaged.

At ClaimLogiq, not only do we offer our services for performing payer’s healthcare claims reviews without denying our clients any transparency into the process. We also offer the ability to customize rules and automations so that they work best for you, and control over each and every aspect of our claim review process, and perhaps best of all, we offer our technology as a software as a service (SaaS).

Offering our TrueCost software as a service (SaaS) means that your team can take the flexibility and control we already offer, and bring it in house to provide your team a tool that will help you innovate payment integrity programs and payment timelines from the inside out.

Bringing your payment integrity program in-house, (this means with remote workers or even a hybrid workforce), can improve efficiencies across the board in order to meet your internal metrics as well as boost provider and memeber satisfaction through faster and more accurate payment processing.

Here are just some of the ways that bringing your bringing your payment integrity program in-house with SaaS can increase cost savings and efficiencies.

Control over your claims auditing

When payers outsource to a typical (not ClaimLogiq) external payment integrity vendor, you run the risk of the vendor having their own way of doing things.

The vendor may not be able to customize edits the way agreements and contracts require. Some vendors can only turn edits on or off.

If you need to edit specific claims in a specific way, and the vendor can’t support that, payers may be stuck reviewing claims manually – back at the drawing board, and paying for it.

With a SaaS like TrueCost™, Payers get control over their entire review process. Change rules entirely, or edit them for a specific provider. Our built-in common library of edits allows for fast, accurate and repeatable assessments of line-level charges.

Standardize your workflows so that your team can be as efficient as possible. Track the KPIs that matter to you, or ignore the ones that don’t entirely. Enjoy total access into historical and real-time reporting and analytics that gives you insights into every claim at every stage so you can easily pivot to optimize personnel, workflows, rules and more.

That’s the power of ClaimLogiq’s software, TrueCost.

Improve Efficiencies

Healthcare claims often have tight deadlines and fast turn-around times in order to meet provider requirements and deliver member satisfaction – but we know that these timelines become unnecessarily extended using an antiquated outsourced method or an inefficient in-house system. But with a software platform like TrueCost that uses a logical and unique payer-facing approach to healthcare payer challenges, you have everything you need to make sure a claim gets analyzed as fast as possible.

Further, when you have an internal platform that your entire team has access to with user-specific access levels, everyone can be on the same page (literally). Meet reimbursement requirements and be more agile by improving efficiencies – internally, and with external review teams.

Move payment timelines farther left when you have the control over your claim review lifecycle that includes intelligent automation and machine learning which evolves over time as your payment integrity program needs move and grow. This creates an environment that becomes even more accurate and consistent with the reduced need for human interaction, leading to fewer errors.

Increase Savings

TrueCost finds savings almost instantly. Remember those rules you customized? The ClaimLogiq Operational Rules and Routing Engine, or CORRE, executes those, and any industry standard edits, to product a pay or pend for review in under 250 milliseconds.

Plans can save literal millions in claims – in under half a second thanks to CORRE.

But while you’re increasing savings, you’re also able to do it with the same number of staff. That’s because while our software is finding errors for you, your staff isn’t spending days combing through a stack of paperwork, only for human error to creep in.

Rest easy knowing your data is safe

With an in-house payment integrity program, or trusting a software to store your clients’ PHI, it’s easy to wonder whether your data is secure.

Our TrueCost software is HITRUST CSF® certified, and a Microsoft Gold certified Data Platform.

And, at ClaimLogiq, our team is fully remote. We’re cloud-based and use our software remotely – so we know you can do the same with your remote claim audits.

You can rest just as easy as we do knowing that you’re safe and secure everywhere.

Go digital by converting documents to text

Just because your claims or medical records are scanned into a PDF format doesn’t mean your team is any more efficient. Successfully moving your payment integrity program in-house is only possible if you have a tool that can move you from a labor-intensive, paper-heavy (physical or digital) review process.

With TrueCost’s ROCR, or Rapid Optical Character Recognition, itemized bills and medical records are converted into searchable and bookmarked text, making it easy to reference data.

Choose an integrated tool to keep everything in one place

While payers often employ a team of internal nurse auditors tasked with reviewing large claims, the process is largely manual and can require printing documents and the use of several disparate systems.

Often, these systems are unable to communicate with each other, further adding to an already cumbersome process.

ClaimLogiq’s TrueCost has everything you need all in one platform. See the total itemized bill – and each and every claim that contributes to it. Take a look at medical records that a provider has submitted, contributing to the claim’s review.

With excellent UX and UI, TrueCost makes it easy for reviewers, clinicians, and everyone in between, to access what they need when they need it.

Collaborate remotely

Remote work is here to stay. Especially with the COVID-19 pandemic, many payers are still working from home. Training your team on a new software while you’re in different locations may be intimidating – but no worries. We’ve got lots of practice.

ClaimLogiq is a fully remote workforce – we’ve been working remotely since before the pandemic! We not only train our clients while remote, but we train our internal employees remotely too.

We’re also able to collaborate easily because our software and our tools are cloud-based. In fact, it means that we keep overhead low.

Cloud-based platforms like TrueCost make remote claim audits possible by enabling all participants to make notes and resolve open issues collaboratively and in real-time, regardless of their physical location. Stop waiting on medical documents or review statuses from other departments, and get a clear idea of where the claim is in the review process by inviting provider team members to the same platform with specific user-level permissions.

Collaborating between virtual employees and external teams doesn’t have to be difficult. With SaaS, you can move away from inconsistent results, even among members of the same department, by collaborating effectively no matter where your team is located.