IBill Reviews and Audits

Promoting Precise Proactive Payment Integrity

ClaimLogiq's automated itemized bill editing includes customizable denial libraries, and feature-rich review functionality that improves the i-bill review speed and accuracy across all team members.

users-cog-light  Razor Sharp Accuracy

ClaimLogiq combines sophisticated machine learning with the discerning element of the human eye. powerful technology identifies errors with precise accuracy, experienced auditors confirm consistent, repeatable outcomes.

database-solid Customized Libraries

Pre-built and pre-populated libraries are complemented by provider specific custom rules, that are adjustable and adaptable. Paired with a full scope clinical analysis, cost savings are immediately identified and payment integrity goals achieved.

cogs-solid-1 Machine Learning

The software "remembers" denials that are unique to provider billing patterns, further automating the process. This enhances relationships while leveraging and defending findings for auditors and appropriate billing processes for future cases.

Hospital Bill Audit <2hrs.

Claims that can take up to 8 hours TAT as an industry average, are returned for amended payment in pre and post-pay within 1.5 hours in ClaimLogiq.

A complex itemized bill review, complete with medical record that produces accurate, consistent cost savings at less than a 9% return rate?  

It's possible.  With ClaimLogiq.

Experienced industry professionals working in our unique payer-facing software system reveal unlimited powers in producing maximum cost savings while enhancing provider relationships.

 

In-House Software

Log into our secure HITRUST cloud-based software from anywhere, utilizing in-house resources to reduce overhead and maximize ROI.

Outsourced Solutions

Outsource to the ClaimLogiq professional claim editors and auditors. We'll use our software to maintain total transparency.

Experienced Auditors

Your medical staff or, ours. Your experienced editors and auditors or, ours. You choose the implementation model of our software.

Simple. Fast. Paid.

Lightning fast speed to payment with zero compromise in accuracy and consistency. Produce predictable, repeatable results at scale.

Itemized Bill Review Tool

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
  • “Learning” platform in which the system remembers denials that are unique to provider billing patterns
  • Robust search and filter functionality allowing users to quickly identify items across many pages of itemized bill records
itemized bill review tool

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 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

Hospital Bill Audit Payment Integrity Icon

Proactive Payment Integrity

Prevent high-cost claim payments without holding up speed to pay. Analyze thousands of pages and complex hospital bill audit requirements in seconds. Reduce the time spent on complex claims with ClaimLogiq technology and in-house or outsourced medical team professionals.

  • Optimization through rule customization 
  • Negative business disruptions
  • Seamless workflow integration
  • Optimized resource and technology environments
  • Incorporates a continuous cycle of business insight and analytics to improve both
    pre-payment accuracy and post-payment capture

 

Team + Technology DNA.

CORREClaimLogiq Operational Rules and Routing Engine is the technology that can adapt to unlimited  provider-specific rules in a pre-built and learned environment. The speed and accuracy at which the software processes complex claims enables accurate, consistent and repeatable results at maximum claim volume levels

<400 Milliseconds

Industry standard edits and client customizable rules for provider-specific contracts enable large claims at any volume to produce a pay/pend in under half a second.

Unparalleled Technology

Payer-facing software, accessible from anywhere in the world with accuracy and consistency that combines the power of machine learning with human experts.

ClaimLogiq itemized bill rules and routing engine

Complete Control

No matter how our claim auditing software solution is implemented, clients have complete control over the in-house and outsourced solution to control outcomes.

Total Transparency

View the life cycle of any claim at any time and maintain a pulse on productivity.  Analyze member metrics and team KPIs, pivot and adjust with customization available at your fingertips.

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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