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.
Customer Service
Utilization Management
Contracting
Encounter Processing
Claims
Compliance & Auditing
Credentialing
Quality Management
(HEDIS Performance)
Provider Services
Financial Services
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
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
A well-designed and well-implemented healthcare Quality Management (QM) program leads to a culture of improving population health and overall healthcare value. QM provides a balanced framework and organizational structure to support this mission while enhancing 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 clients’ contracted networks. Experienced medical directors, nurses, and case managers follow each patient through the healthcare system. Continuous reviews of inpatient and outpatient services ensure that the utilized facilities and resources are both appropriate and provide quality care.
Our Utilization Management (UM) committee includes board-certified physicians with expertise in an array of specialties who provide the knowledge required for our members to receive the most appropriate medical care. Subsequently, our comprehensive utilization management and review processes protect against unnecessary or inappropriate medical services. 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 decision-makers do not encourage decisions that result in underutilization.
Utilization Management
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
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
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).
Financial Services
Our finance department offers planning, organizing, auditing, forecasting, and reporting. We also provide general accounting and accounts payable.
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