DRG Validation

Lower Appeal Rates

Communication is key to all provider and client relationships to limit further disputes and expedite the the collection of the overpaid dollars. Lower appeal rates directly influence improved provider relationships.

Experienced Auditors

Every DRG auditor has a minimum of 10 years of audit experience and has industry-relevant certifications. Auditors have a deep knowledge of high-cost drugs and large claim procedures and receive continuous improvement training.

Controlled Outcomes

The implementation of pre-built industry edits and pre-screen rules results in a continuous improvement loop. This can be customized and controlled by the client for specific payer-provider needs.

DRG Reviews Tool

Our DRG validation tool offers analysts pre-screen 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

Smart Routing

Automated and adjustable workflow rules that consistently anticipate the production needs and route to the right team member for speedy and proper adjudication

Built-in Calculation

Predefined standard and custom calculation rules and edits improve the machine learning feature over time and empower auditors to achieve accurate and consistent results

Pre-Screen Rules

Industry-standard and custom pre-screen rules reduce overall claim workflow and automates the claim auditing process

Cloud-Based

Our HITRUST certified DRG validation solution utilizes rules-based algorithms that target potential coding anomalies and/or documentation improvement opportunities at the time of coding completion

Measurable Metrics

Keep a pulse on productivity and workflow efficiencies, know where to focus workforce attention to adjust and adapt to claim needs real-time

Repeatable Results

Increase accuracy, compliance, and quality, through dashboards, reporting, and closed loop communications and feedback

Technology + Team

Above industry-standards results, fastest speed to pay and consistent, accurate and repeatable results that can only be delivered by the powerful combination of machine learning technology and claim auditing experts.

CORRE (ClaimLogiq Operations Rules and Routing Engine); learns over time and automatically adapts and adjusts
Experienced professional claims analysts
Clinical rationale drives to reporting as well as provider correspondence
Consistent, controlled outcomes reduce provider appeals and abrasion