A best-in-class technology platform that enables health plans to optimize payment integrity programs through a more proactive SaaS, Service and HyBrid model.
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More than technology alone, ClaimLogiq can support your entire Payment Integrity workflow.

Itemized Bill Review

Delivering accurate and consistent results in <15 minutes. ClaimLogiq capabilities include automated bill editing, denial libraries and functionality that improves review speed and acuracy.

Clinical & DRG Validation

Our validation tool offers pre-screen rules catered to each players unique review protocols, claim routing to appropriate team members, and consistent results to reduce provider appeals.

Analytics

The first step to knowing what's in your data is accessing it. ClaimLogiq's NLP capabilities powered by SyTrue unlock insights from unstructured and structured data so you get analytics based on the whole truth.

SaaS, Services or Hybrid 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 or, as any combination of the two, tailored to each Payer and payment integrity program need.
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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 TrueCost, 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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“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

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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Hospital Itemized Bill Review

<15 Minutes

ClaimLogiq's end-to-end solution, TrueCost™, and intelligent tech tools

provide Payers in-house or outsourced capability to handle complex claim reviews in under 15 minutes.
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CORRE

Using provider-specific and industry edits, claim files are matched to criteria for a pay or pend for review result in under 250 milliseconds.

ROCR

ClaimLogiq's Rapid OCR tool scans IBills of varying sizes and types with multi-threaded capability to normalize data in minutes, even seconds, for immediate review in TrueCost.

TrueCost

ClaimLogiq's cloud-based claim-analyzing platform presents complex facility reviews to analysts for review delivering accurate and consistent results in under 15 minutes.

Single platform, entire audit management

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

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.

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.

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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Video: Our Approach

Large claim reviews are essential to payment integrity, so ClaimLogiq developed TrueCost to simplify the process, provide better ROI, and reduce 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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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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