Read our experienced team's thought leadership and insight for all areas regarding healthcare claims auditing, payment integrity, provider relations and cost avoidance.
All payment integrity programs are not created equal. The process for implementing a payment integrity program will look different for every healthcare plan -- and for good reasons. However, it is possible to successfully implement these differing payment integrity programs in under 90 days with the right business partnership and aggressive (yet very achievable) tactics and strategies. 90 days might seem ambitious, but, when payers work with a partner that is capable of bridging any gaps in the implementation process, it is possible to achieve swift implementation timelines. When we approach all client relationships as true business partnerships, it benefits all areas of every program execution. Our operational execution is second to none, our team is stacked with experts with decades of experience in the payment integrity space, and our TrueCost solution offers transparency, client-driven control, customizability and flexiblity to meet every need. These factors are what sets ClaimLogiq apart -- not just during the implementation phase -- so we're ready to move as fast as our clients can when it comes to crossing major milestones of any program implementation.
Some of the trends on the horizon this year may be familiar as they’ve been emerging over the years. The healthcare industry is nothing short of a behemoth and although not resistant to change, it can be rather slow to adapt, even when health crises demand it. However, the eruption of COVID-19 in 2020 and the continuation of the pandemic into another year has put pressure on the healthcare industry to make rapid advancements and sharply change direction, in many cases.
Scientists and doctors are constantly innovating to find new and better ways to learn about, treat, or even cure ailments or diseases that affect us. There will always be a newer, possibly better solution on the horizon. However, innovations in healthcare shouldn't be taken for granted. In fact, it's important that we don't think of innovations in health care as expected or able to be achieved with the same players, but rather, encourage those willing to find new solutions to do so.
The impact of the pandemic hasn't been a ripple effect, it's been more like a shockwave to the healthcare industry, insurers and employer health plans (just to name a few in the payer space). It's safe to say no matter who you are, there is an immediate visceral reaction to the impact "Coronavirus" or, "COVID-19" is having on lives, every day. Specifically, the impact on employer sponsored health insurance plans revolves around massive job losses and, although the immediate affect has been staggering, as we enter the second half of 2020, there appears to be some up-ticks in positive notes about the still, very challenging road ahead.
Industry News: Health insurance companies are calling on Congress to provide more funding to help people keep coverage, citing the more than 44 million who have filed for unemployment since the coronavirus crisis started. The two main health insurance lobbying groups, America’s Health Insurance Plans (AHIP) and the Blue Cross Blue Shield Association, wrote a letter to congressional leaders on Friday making a range of requests for the next coronavirus response package, expected later this month.
What are the costs for payers, providers and patients in moving towards a historic healthcare price transparency model? We know that payers and providers negotiate specific pricing tiers and strategy regarding both small and complex healthcare visits and procedures, but, what would that look like up-front to the patient?
3 Ways ClaimLogiq is Disrupting the 'Black Box" Model of Claim Auditing Sending claims out for audit and waiting on the results to be delivered without any insight into, or control over, the process, is commonly referred to as the 'black box' model of claims auditing. This is especially true of an often disparate process of reviewing high dollar claims, particularly Itemized bills and DRG validations.