Logical Approach

No More 'Black Box' Claim Auditing

We've removed the mystery surrounding the process . Get real-time insight and hands-on access to every claim at every stage.

Our software allows for the most logical and simplified breakdown of even the most complicated, largest healthcare claim. Our approach to a software solution is purely logical - clients want control and transparency and we've made the team and technology that can provide exactly that and produce the most cost savings and predictable outcomes.

Simplified Approach

It's in our name, ClaimLogiq. We take a logical approach to large, complicated, high-dollar claims, and simplify the entire lifecycle. This gives control to our clients through total transparency over the entire claim auditing process.

SaaS or, Services

Our powerful and HITRUST certified software can be used by in-house payer teams or, used by our team of clinical experts as a services solution to find maximum cost savings complemented by tools for enhanced provider relationships all within a single platform.

Payer-Facing

A unique claim analyzing and payer-facing software platform gives secure access and real-time insight into the claim auditing process, advanced analytics, and customization for rules and workflows. All mediated by machine learning technology that provides accurate, defensible and repeatable outcomes.

Logical Approach to Helathcare Payer Payment Integrity

Logical Payment Integrity

ClaimLogiq completes high-dollar, large complex claims in the fastest amount of time without compromise in accuracy or consistency. Industry experts deliver repeatable and predictable results alongside smart technology that routes the right claim to the right person every time. Payers enjoy virtually unlimited volume and enhanced provider relationships for long-lasting payment integrity.

SaaS, Services and Combination Models
DRG Validation
I-Bill Reviews
RBP and LOC
Pre-Pay and Post-Pay
Facility and Professional Claims

Transparent Claim Auditing

The ClaimLogiq approach involves giving control of large, complex claims back to healthcare payers. This allows for transparency over the entire process and a fully developed simplified solution as a business partner, not just another vendor. This then results in defensible results through complete customization for every provider and payer agreement.

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

Optimize Workflows

Efficiently move complex claims through workflows using smart routing and machine learning automated rules and edits. Scale over time and learn at the pace of specific agreement requirements and industry demands.

Improve Productivity

Maximize performance and improve the productivity of team members and claims! Using our payer-facing software that provides real-time insights into the process, it's possible to pivot and customize our platform to the specific needs of payers and provider agreements as your business evolves.

Drive Better ROI

See lower return rates, faster speed to payment, reduced effort, and resources with greater control over the entire process. Cost savings that smash industry averages all while allowing payers to provide ClaimLogiq as an expert solution or, white-label offering for providers.

Client-Controlled Outcomes

When payers have real-time access into every claim and ClaimLogiq software utilizes smart automation and right-team routing, clients have the power to control outcomes for the lowest possible provider abrasion statistics while maximizing cost avoidance and producing greater savings.

Reduce Resources

Utilize ClaimLogiq HITRUST software in-house or, out-sourced as services. Our team or yours, our software is utilized to reduce resources for both internal and external stakeholders. Use less staff, less time, and less equipment to audit complex claims of any size and any volume for any type payer.

Data Management

HITRUST certification ensures the safest and most secure management of data that crosses our cloud-based healthcare payer claim auditing software. Access data securely and logically by specific team member access, release information as dictated by agreements and contracts and adjust permissions real-time.