Services
Unilogic brings healthcare organizations what they need in order to provide quality care.
People. Processes. Strategies. Solutions.
From IT to customer care to office management systems, Unilogic delivers.
Compliance & Auditing
Credentialing
Financial Services
Quality Management
(HEDIS Performance)
Claims
Customer Service
Information Technology
Utilization Management
Contracting
Encounter Processing
Provider Services
By closely watching changing healthcare guidelines, laws, and regulations, we ensure total compliance with all payer requirements. In ensuring all management actions are in the best interests of members and the organization equally, we keep client risk at an absolute minimum.
Compliance & Auditing
Timely, accurate claims adjudication must be a healthcare operation’s single most important function. Unilogic’s program integrity depends on accuracy in all key data points feeding risk adjustment and overall quality. We ensure encounter data is accurate, complete, and fully represents provided healthcare services.
Claims
Contracting
Our managed organizations’ financial interests are our financial interests. By thoroughly examining each contract’s details, with an emphasis on language and matrix of responsibility, we deliver to our managed groups the highest possible benefits. We’re equally dedicated to development, working to expand and increase networks for greater access to better services.
Credentialing
We facilitate all verification of credentials for our networks’ contracted providers. By working with a Credentialing Verification Organization (CVO), we procure the required primary source verifications for compliance with the National Committee for Quality Assurance (NCQA).
Our call center’s knowledgeable, caring associates track and log all member queries for prompt, proper follow-up and future reference. They field and address calls relating to all areas of healthcare management and delivery, including benefits, eligibility, scheduling, social services and resources, and more. In addition, our call center professionals place outbound calls to members—to welcome new enrollees, for appointment reminders, and for health screenings—to engage them in their own healthcare. Frequent satisfaction surveys help Unilogic assess organizational performance and pinpoint any areas in need of improvement.
Customer Service
Our process is efficient, accurate, and effective. Receiving accurate and complete claims from providers helps ensure timely and total encounter data production. Our process includes:
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Reconciliation review
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Claims to encounter
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Vendor status reports
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Acceptance and reject review
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Financial encounter balancing and reconciliation tracking
Encounter Processing
Financial Services
Our finance department plans, organizes, audits, forecasts, controls, and accounts for Unilogic’s finances, including general accounting and accounts payable.
Information Technology
To support our clients’ technological needs, we provide a fully equipped IT infrastructure, with software available upon request for development of special reports and analysis. To keep our managed groups fully knowledgeable on their networks, Unilogic IT monitors and tracks business trends affecting technology required for healthcare operations.
Unilogic’s clients have daily access to our Provider Services Representatives and Network Development Managers, who serve as a point of contact between health plans, IPAs, and providers. A dedicated team for each network focuses on accurate provider communication, network/business development, and education.
Provider Services
A well-designed and -implemented healthcare Quality Management (QM) leads to a quality culture of improving both population health and healthcare value overall. QM provides client- and leadership-driven balanced framework and organizational structure to support Unilogic’s mission and vision, while enhancing both client and member outcomes. Our ultimate purpose in measuring quality improvement? Improving our community’s health … one patient at a time.
Quality Management
Unilogic processes all requests for authorizations for our contracted managed-care IPA networks, with experienced medical directors, nurses, and case managers following each patient through the healthcare system. Continuous reviews over inpatient and outpatient services helps ensure the utilized facilities and resources are both appropriate and providing quality care.
Our Utilization Management (UM) committee includes board-certified physicians with an array of specialties, providing the knowledge required for our members to receive the most appropriate medical care. Subsequently, our comprehensive utilization management and review processes saves our managed groups from unnecessary medical costs. All UM program policies and procedures are available to practitioners, members, and the public upon request.
Affirmative Statement
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UM decision-making is based only on appropriateness of care and service and existence of coverage.
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The organization does not specifically reward practitioners or other individuals for issuing denials of coverage.
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Financial incentives for UM decisionmakers do not encourage decisions that result in underutilization.
Utilization Management
