Payment Integrity

Maximize cost savings through expertise in real-time data and actionable analytics.

Powerfully Precise Payment Integrity.

The ClaimLogiq approach to payment integrity includes a proactive and smart adaptation of core systems logic that is customizable, learns over time and is leveraged by seasoned healthcare industry experts.

file-code-light-1 Totally Transparent

Seamlessly move across the entire claim life-cycle without disruption to payment or providers.  Adjust and evolve in real-time to meet the needs of a fast-paced industry.

database-solid-1 Coordinate Cost Containment

Optimize resources and enhance accuracy with both immediate and long-term opportunities improving efficiency and scale-able cost savings over time.

shield-alt-regular Balance Challenges

Minimize disruption to providers by customizing your solution framework with the specific needs for provider contracts, policies, industry guidelines and best practices and regulations.  

Logical Payment Accuracy.

Achieve consistent and accurate payment resulting in reduced strain on payers, providers and other stakeholders.

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Ensure Consistency

Uncover more savings opportunities with automatic identification of errors and provider-specific rules. The technology learns and adapts to meet cost savings goals and deliver minimized abrasion.

Control Outcomes

Healthcare payers have the control to maximize cost avoidance and effectively manage provider relationships with ClaimLogiq's custom and transparent technology.

Repeatable, Reliable Results

Ensuring total transparency and complete control means that healthcare payers of any size and any claim level complexity can achieve predictable outcomes on a consistent basis.

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Achieve payment integrity through custom implementation at any stage of the claim lifecycle.

Improve Performance

Push your claim editing and auditing to the max and define new thresholds for accuracy, consistency and production.  Claimlogiq's real-time analytics and adjustment technology gives everyone the tools needed to pursue impeccable payment integrity.

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Workflow Management

Manage claims and personnel at every stage to ensure an adaptable software and people environment.  Customize the payer-facing UI to evolve with provider-specific and key performance indicator benchmarks.

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DRG Validation

Our DRG validation tool offers analysts prescreen rules designed to select the claims best suited to payer’s unique review programs. These rules are tailored to fit the specific needs of your provider contracts and plan design

  • Workflow controls that route claims to the appropriate team member
  • Built-in DRG calculation for every claim
  • Consistent denials which reduce provider appeals over time
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Payment Integrity DRG Validation
Payment Integrity Hospital Bill Audit

Hospital Bill Audit

  • Our itemized bill review capabilities include automated itemized bill editing, customizable denial libraries, and feature-rich review functionality that improves the i-bill review speed and accuracy across all team members for in-house or, outsourced solutions

    • Automatically identified denials that are presented to the user for validation
    • Consistent itemized bill views regardless of the provider billing format
    • Consistent denials which reduce provider appeals over time
    • Robust search and filter functionality allowing users to quickly identify items across many pages of itemized bill records
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  • Out-Of-Network Claims

    Experience zero distruption in workflow with the fastest speed-to-pay automation for out-of-network solutions.

  • Claims Editing

    Generate accurate, provider-specific compliant claims analysis using in-house software or, outsourcing services.

  • Referenced Based Pricing

    Go beyond cost savings and containment with sustainable, scaleable cost management.

Experience our dedication to payment integrity.

See for yourself how ClaimLogiq can adapt the highest level of payment integrity to all claim environments at any stage of the claim life-cycle.  Recoup costs, avoid over-payments and grow relationships with stakeholders.

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Our Unique Approach

We help healthcare payers of all sizes overcome the complexities of healthcare claims through a transparent and customizable software solution.

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