Payment Integrity and Risk Adjustment Solutions

Empowering health plans with better support, comprehensive tools and advanced technology.


Payment Integrity Solutions

We’ve developed a complete end-to-end solution that empowers payers to finalize reviews for maximum savings and recoveries in under 15 minutes.


Itemized Bill Reviews

Our 15-minute Itemized bill review capabilities include itemized bill editing, customizable denial libraries and feature-rich review functionality.

  • Automatically identified denials are presented to the user for validation

  • Dependable reviews equipped to handle any provider billing format

  • Robust search and filter functionality allows users to quickly identify items across various pages of records

Clinical & DRG Validation

Our DRG Validation tool offers analysts pre-screen rules designed to select the claims best suited to payers’ unique review programs. Rules are tailored to fit specific needs of your provider contracts and plan design.

  • Consistent denials help reduce provider appeals over time

  • Workflow controls route claims to appropriate team members

  • Built-in DRG calculation for every claim

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Measurable Metrics

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Repeatable Results

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Pre-Screen Rules

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Smart Routing

Risk Adjustment Solutions

Our technology enables the completion of Risk Adjustment reviews with all the efficiency of data-supported diagnosis extraction and HCC mapping. Harness the power of automation with a program that delivers results consistently and accurately.

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Clinical Data Extractions


Our Advanced Machine Learning NLP technology processes unstructured and structured documents to extract key data insights, reducing the time it takes to perform chart reviews.

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Data Supported Diagnoses


Solutions that allow users to capture supporting documentation for each diagnosis, ensuring accurate and defensible results.

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HCC-ICD Mapping


Extract data longitudinally and map ICD to HCC codes while considering reporting period, version and other key elements.

Extract Meaningful Data

Sometimes all you need is data, and when 80% of it is unstructured, in different formats and in various locations, it can be difficult to extract meaningful insights. Using Advanced Machine Learning NLP Technology, we process records one time, extracting semantically accurate and interoperable data to feed your analytic models.

Medical Data Complications

  • Unstructured data can’t feed complex models

  • Documentation typically comes in the form of thousand-page PDFs

  • Skilled physician/nurse review is costly and time consuming

  • Data quality and normalization challenges are complicated


Claims Auditing

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Empower auditors to quickly validate key findings through a modernized, customizable workflow.

60% - 70%

on Low-Touch

6x - 8x

Increase in

Risk Adjustment

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Identify medical records’ key components to support risk adjustment and map to applicable HCC codes.


Precision with
NLP-Guided ICD Extraction


More Findings
than Manual

IQ Insights Blog

For more on our comprehensive payment integrity and risk adjustment solutions or behind-the-scenes news at ClaimLogiq, visit our IQ Insights Blog.