Logical DRG Validation

Communication and Close Attention to Detail.

ClaimLogiq's unique payer-facing technology and proven solution DRG validation strategy yields optimal recoveries with not just maximum cost avoidance but also minimized abrasion and enhanced relationships.

envelope-open-text-light  Lower Appeal Rates

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

users-cog-light 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.

server-solid 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. 
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60
% Change Rate

4
Hrs Avg. Review TAT

9
% Return Rate
DRG Review Tool Icon

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

The ClaimLogiq Difference

Experience smarter software adaptations combined with industry experts that can be implemented as an in-house software solution, outsourced services, or any combination of the two.

For any payer and provider relationship, any claim type with maximum volumes.

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 automate 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
CORRE System Claim Audit Workflow

Technology + Team 

Above industry-standards results, the 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


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Custom, Transparent, Logical Solutions, Delivered.

Take a tour of our comprehensive client claim solutions. Discover a unique payer-facing software solution that can be implemented to meet specific payer and provider needs. Reduce overhead and increase accuracy with an in-house solution and make workflows efficient with faster speed to pay as an outsourced service.
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We're a leading provider of healthcare software and technology, innovating the path forward for proactive payment integrity. 

 

We make claims logical, because to us - it's personal.
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