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Does your processing system enable you to identify inaccurate or redundant claims and flag unnecessary medical procedures? The ClinicaLogic component, integrated with the TriZetto® QicLink™ system, helps you lower claims costs and pinpoint quality-of-care issues. ClinicaLogic automatically checks for physician billing errors, identifies and calls attention to unusual or unnecessary treatment patterns, and flags potential catastrophic cases for intervention and management. Changes recommended by ClinicaLogic typically reduce processing costs by 5 percent to 15 percent.
ClinicaLogic is a comprehensive, knowledge-based clinical-editing component that automatically checks medical claims during adjudication. ClinicaLogic analyzes current claims in the context of complete episodes of care and patient history, while automating the identification and extraction of claim and related data for editing. It adheres to care and billing standards established by national medical societies, yet offers you the flexibility to customize parameters for claims editing in order to comply with unique provider payment policies and guidelines.
Benefits
- Reduces costs and quantifies savings, by identifying inaccurate or redundant claims and flagging or correcting unnecessary procedures.
- Simplifies tracking and automatically identifies and calls attention to potential catastrophic cases for intervention and management.
- Eliminates coding errors and strengthens data integrity.
- Applies a consistent screening methodology based on unique group/plan specifications.
- Reduces disputed claims, by recommending actions and, in some situations, automatically correcting common coding errors.
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Information
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For more detailed information, please call 1-800-569-1222 or click on the link below.
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