ClaimLogiq IQ Insights

Read our experienced team's thought leadership and insight for all areas regarding healthcare claims auditing, payment integrity, provider relations and cost avoidance.

All Posts

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 Vice President of Brand Marketing and Communications, 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 Communications and holds a bachelor’s degree from the University of Kentucky.

Related Posts

How the 15-Minute IBill Audit Transforms the Payment Integrity Landscape

While the typical hospital claim review can take days to weeks – ClaimLogiq’s solutions empower analysts to finalize reviews in hours, even minutes. Now, ClaimLogiq has announced the 15-Minute IBill audit as part of our regular claim lifecycle audits.  The breakthrough 15-Minute IBill Audit is game-changing for payers of all shapes and sizes. Now, lengthy audits for complex hospital itemized bills, and unavoidable overpayments and recovery efforts, are a thing of the past.

How the 15-Minute IBill Review Works – Explained

Our 15-Minute IBill Audit is an end-to-end solution that allows healthcare Payers of any size, shape, or scope to produce quality itemized bill reviews in under 15 minutes. We're maximizing automation with intelligent software and technology that learns and adapts to specific program needs. See first-hand, how the workflow is optimized at every step to minimize provider abrasion, accept customizations, and evolve at the speeds of the healthcare industry.

How to Successfully Implement your Payment Integrity Program in Under 90 Days

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.