We Make Claims Logical.

Because, to us - it's personal.

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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 is facility claims. ClaimLogiq’s technology platform provides a means to finally gain control of your internal review department.
We know that a claim is more than a stack of paperwork, so we're more than software alone.
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Our Approach.

Large claim reviews are essential to payment integrity, so ClaimLogiq developed a software simplifying the process that provides better ROI, reduced resources with repeatable, consistent, and accurate outcomes.

  • Fastest Speed to Payment
  • Higher Consistency and Accuracy
  • Reduced Provider Abrasion
  • Greater Cost Savings
  • Proactive Payment Integrity.
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We're Business Partners.
Not Just Vendors. 

 

ClaimLogiq empowers payers to improve large claim review outcomes by providing a HITRUST certified payer-facing software solution. This enables total transparency by customizing built-in tools and expert resources and giving clients control of the entire claim process.

Single Platform, Entire Audit Management.

ClaimLogiq can house your entire claim auditing process and management in a secure, cloud-hosted user-friendly application that clients can access from anywhere using internal resources or, ClaimLogiq outsource solutions.

Eliminate Outsourcing

ClaimLogiq empowers clients to utilize in-house team resources with our powerful software to yield client-controlled outcomes.

Employ Fewer Resources

Yield optimal recoveries with not just maximum cost avoidance but also minimized abrasion and enhanced relationships.

Fewer Appeals

Razor-sharp accuracy leads to fewer appeals alongside high-trained team members and clinical experts to drive total confidence in results for both payers and providers.

Achieve Consistency

Consistency goes hand-in-hand with repeatable and accurate payment results. Providers enjoy reliable contact, and payers see scale-able growth.

Proactive Payment Integrity

Change the way you approach payment integrity. Realize accurate audits and true cost savings with a proactive approach using up-front industry rules and custom edits.

Real-Time

Watch the lifecycle of a large claim during any step of the process. Adjust team members, adapt software and technology and analyze metrics, real-time to control results.
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Customizable Claim Solutions

We design solutions for a constantly evolving healthcare claim environment. We help payers improve their claim review outcomes by providing tools to simplify and take control of the process.
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DRG Validation.

  • 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

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


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Itemized Bill Review

  • Denial libraries that are customizable for each provider
  • Consistent denials reduce provider appeals over time
  • Experienced hospital bill auditors 
  • The learning system remembers denials that are unique to provider billing patterns
  • Robust search and filter functionality allowing users to identify items across many pages of itemized bill records quickly

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


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SaaS or Services Model.

ClaimLogiq offers a unique payer-facing solution that can be provided as a solution to reducing resources with an in-sourced model or driving cost savings with a services-based model.
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Claim Review Outsourcing.

  • Ability to flex claim volume without increasing internal staff
  • Seamlessly send specialize or seldom-encountered cases to ClaimLogiq as needed
  • Pre-established rules and protocols drive reviews; the platform keeps payers and ClaimLogiq staff aligned

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


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SaaS Cloud-Hosted Model

  • Paperless cloud-hosted secure, HITRUST certified platform.
  • Completely transparent rules, edits, and denials that are customizable by plan and provider
  • Algorithms that learn provider-specific denials which are utilized in future cases
  • Cross-claim validation ensuring agreement between professional and institutional claims

Utilize our unique payer-facing cloud-based solution to control outcomes, reduce provider abrasion, promote productivity and retain complete control over the claim auditing process.


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Team + Technology DNA

It's the unique approach to payer-facing software through a combination of sophisticated technology and industry experts that healthcare payers receive faster speed to payments and reduced provider abrasion.

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Industry-standard edits and client customizable rules for provider-specific contracts enable large claims at any volume to produce a pay/pend in under half a second.

Unparalleled Technology

Technology that truly bridges the gap between software and service. Combining client control and transparency for results capable only with ClaimLogiq.
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Razor Sharp Accuracy

Speed means nothing if accuracy and consistency cannot accompany it. ClaimLogiq has that solved through accurate and predictable outcomes with repeatable results.

Unmatched Process

Machine learning technology grows and adapts over time to meet the future requirements of provider contracts and payment integrity agreements.

CORRE; ClaimLogiq Operational Rules and Routing Engine is the technology that can adapt to unlimited provider-specific rules in a pre-built and learned environment. The speed and accuracy at which the software processes complex claims enables accurate, consistent, and repeatable results at maximum claim volume levels.
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“The medical directors' work on ClaimLogiq’s platform is possible only because of the work ClaimLogiq and their staff do in these sometimes very complex cases! Thanks for all your help and flexibility in dealing with our questions!”


– Medical Director at Mid-sized Blues Client

Better Audit Tools and Resources.

When the control is in the hands of the client, claim auditing becomes a collaborative and innovative process that is simplified for speed and accuracy.

Collaboration

We believe in a partnership between our teams and in true collaboration with clients.  This translates to confidence in people and product that delivers unmatched results.

Clinical Experts

Our team is comprised of healthcare, software, and payment integrity experts with decades of experience.

Scaleable

Scale quickly and easily with our core integrated software model and technology, no limits on resources or claim volume.

Unlimited

Virtually unlimited rules, edits, claim volume, and power with the ability to continue accurate and fast results.

Predictable

When processes are transparent, and clients have control, results become repeatable and predictable with consistency and accuracy at the core.

Controlled

Total client control over the design, process, changes, and evolution of a claim life cycle taps into resources efficiently and effectively.

Agile

Software, not vaporware, produces a truly technological agile environment that can be manipulated to handle any type or size claim at the speed of your needs.

Powerful

Pay or pend results produced in under half a second, and complex claims that have a turnaround time of under hours, not days, point directly to the powerful engine behind ClaimLogiq.
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Simplifying The Process.

ClaimLogiq takes a unique approach to simplify the complex claim editing and auditing process. By providing total transparency and offering payer-provider-specific customizations, clients have complete control over the process and therefore, of all outcomes.
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Improve Productivity.

  • Utilize real-time analytics and member metrics to keep a pulse on the entire workflow
  • Increase ROI with software designed to make work efficient and effective
  • Drive results though consistent outcomes.

ClaimLogiq's client-facing software approach allows auditors to manage the claim process and managers to optimize performance and productivity at-a-glance or, through detailed reports and metrics.  All available real-time.

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Total Workflow Management.

  • Manage workflows of any size or type claim using ClaimLogiq as SaaS, service or, a combination of the two
  • Optimize complex workflows with our innovative approach to streamlining the claim auditing process
  • Enjoy complete control over your team and claims, quickly and easily adjust and adapt as the environment evolves.

Decrease the amount of resources and time spent on complex claims.  Large claims with high-dollar value, complicated audits, and high volume provide no challenge to ClaimLogiq's software, technology, and experienced team.

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Learn More About Our Logical Solutions.

Our unique approach to simplifying complex claims and the auditing process is to give control back to the client.  This enables predictable, repeatable outcomes in a customized environment, so healthcare payers have complete control over maximizing cost savings and enhancing provider relationships.

We're a leading provider of healthcare software and technology, innovating the path forward for proactive payment integrity. 

 

We make claims logical, because to us - it's personal.
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