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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 tool provides real-time and historical views into the status of every claim, regardless of what stage of the review process. TrueCost allows you to:

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

Contact our team to discuss how we can transform your payment integrity goals.Disrupting the Black Box Model of Claim Auditing

2) Customization


,TrueCost is the leader when it comes to customization and supporting your provider relationships. 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.

Automation and machine learning, combined with provider-specific capabilities, enables payers to review more claims in less time with consistent and reliable 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 clients can 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.

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.

Brian DeRoy
Brian DeRoy
Claimlogiq Marketing Communications Manager. Inner city public high school grad, son of a construction worker - blue collar roots and work ethic with a college degree who believes in four simple words: Relevant, Timely, Unique & Simplified. Big believer in employee and audience engagement by taking complex topics and making them understandable to the masses. A successful TV news career drives Brian's communication style - he rarely misses an edition of his favorite TV show, ABC World News Tonight with David Muir.

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