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.
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.
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.
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.
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
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.
Automated and adjustable workflow rules that consistently anticipate the production needs and route to the right team member for speedy and proper adjudication
Predefined standard and custom calculation rules and edits improve the machine learning feature over time and empower auditors to achieve accurate and consistent results
Industry-standard and custom pre-screen rules reduce overall claim workflow and automates the claim auditing process
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
Keep a pulse on productivity and workflow efficiencies, know where to focus workforce attention to adjust and adapt to claim needs real-time
Increase accuracy, compliance, and quality, through dashboards, reporting, and closed loop communications and feedback
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.
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.