ClaimLogiq IQ Insights

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Disrupting The 'Black Box' Model

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.

 

At ClaimLogiq, our staff of healthcare and technology experts are dedicated to making the complex, simple. For healthcare payers, this means addressing the convoluted process and disrupting that very ambiguous concept of the black box.  Our method involves giving control of these claims back to healthcare payers, allowing for transparency over the entire process and developing simplified solutions as a  business partner, not just another vendor, resulting in defensible results through complete customization for every provider and payer agreement.

ClaimLogiq disrupts the black box model through three core pillars; transparency, customization and client control.

 

1) Transparency 

Our TrueCost platform provides real-time and historical transparency into the status of each and every claim, regardless of what stage it’s in in the review process. What if you could:

  • Review correspondence between analysts and medical directors
  • View medical records and provider communications
  • Review clinical rationale
  • Run real-time and historical reports
  • And track the routing of every claim… all within a single platform


With ClaimLogiq, you can do that… and a whole lot more.

Contact our team to discuss how transparency can transform your payment integrity goals.

Disrupting the Black Box Model of Claim Auditing

2) Customization


When it comes to customization and supporting your provider relationships, TrueCost is second to none. Healthcare payers benefit from the platform’s ability to run pre-screen rules and other provider-specific edits in an instant during the audit process.

Features like automation and machine learning, combined with those provider-specific capabilities, enables payers to review more claims in less time with consistent and defensible results.

When that happens, provider abrasion is minimized.

Talk to an expert about customizing your claim auditing workflow for maximum efficiency and optimized provider relationships.


3) Control

Best of all, the TrueCost platform gives healthcare payers complete control over the audit process… and their payment integrity programs as a whole. Because of the real-time transparency and the provider-specific customization, our healthcare payer clients are able to adjust their program rules and adapt to trends as the program matures.

Imagine being able to throttle down the claim selection process so as to minimize the number of claims chosen for audit from a particular provider. Or, imagine being able to edit or add a rule on the fly that applies solely to claims coming from a particular provider or group of providers and seamlessly applying that new rule to all future claims.

With ClaimLogiq, that’s a reality.

Gain control over the entire claim auditing process through transparency, customization and client-driven control.  Optimize outcomes and reduce provider abrasion with virtually no limits on claim volume, size or, complexity. 

Don't accept the the lack of control around the black box model and remove the mystery from claim auditing with ClaimLogiq.

 

 

Learn how to improve your payer payment integrity goals alongside improving provider relations and maximizing ROI immediately.  Disrupt your black box model approach by working with ClaimLogiq and our team of experts.  Contact a solutions expert, today.

Rebecca L. Price
Rebecca L. Price
As the Director of Marketing, Rebecca leads the strategy for ClaimLogiq communications and engages with ClaimLogiq's audience through social media and other digital platforms. Rebecca has decades of experience writing about software and technology and has produced informative healthcare innovation materials in the form of white papers, print and video content. Rebecca studied Integrated Strategic Communcations and holds a bachelor’s degree from the University of Kentucky.

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Disrupting The 'Black Box' Model

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.