Service Model

New clients have their historical claims analyzed by the Business Rule Generator so that subsequent claims may be examined by the Quality Issue Flagging Service. There is no charge for business rule generation. Accessing the Quality Issue Flagging Service costs a flat monthly fee.

TraumaQi™ Business Rule Generator

• Examines all claims from the trauma center since October 2007 (when CMS-DRG was replaced by MS-DRG) using a database of UB-04 claim forms (a standard form used in insurer billing)
• Uses statistical techniques to determine the conditions under which the trauma center is significantly at risk of producing a claim containing a quality defect that will reduce revenue
• Creates business rules that can be applied in real-time by providers to identify potentially problematic claims that need to be double-checked
• Includes an onsite meeting with members of the trauma center staff to improve claims workflow, meet with internal champions, and determine whether there are factors not visible in the data that are influencing outcomes

TraumaQi™ Quality Issue Flagging Service

• Performs automated claim flagging on UB-04 claim forms
• Includes periodic updates to your trauma center’s business rules for flagging claims, performed by passing your most recent UB-04 claim forms through the TraumaQi™ Business Rule Generator
• Includes an annual site visit by a TraumaQi™ expert to help reinforce the importance of the quality initiative, maintain buy-in, answer questions, and learn about changes in the trauma center that may impact TraumaQi™