Medlogix Software

CSG's proprietary software solution for providing outcomes and decisions critical to maximizing efficiencies and ROI in the complex world of medical claims management.

Created by industry-leading developers, insurance professionals and managed care specialists, this powerful platform seamlessly integrates technology with the latest regulatory guidelines, medical best practices and business-partner interfaces. Incorporating decades of industry experience, this secure, flexible, scalable and robust solution integrates all CSG services to consistently exceed client, regulatory and business partner demands. All modules include comprehensive EDI capabilities to fully integrate with any claims system, either standard or proprietary.

Technology...the heartbeat of medlogix®

Workflow
Jobs & Tasks drive inboxes with access controlled by user roles - monitors inventory & efficiency.
Rules engines
Customizable rules drive automation and consistency.
EDI
Electronic data interfaces for eReferral, eData, eImage, eInvoice, ePPO.
Faxing
Integrated incoming & outgoing with confirmation receipts.
Imaging
User supported uploading & downloading of images with full document research & management.
Accessibility
medlogix®Online web portal with dashboards, inboxes and 24x7x365 secure access.
Managers
Software intelligence through various system managers sharing rules and outcomes.
Tools
Research and analysis tools providing valuable insight into claim and provider activity.
  • Claim Summary
  • Provider Analysis
  • Care Plan Summary
Quality Control
Automated rules and checks to assure highest possible quality.

Medical Intelligence through Technology

Technology drives all CSG services. Numerous system managers combine predefined rules with medical outcomes to create consistent, intelligent and flexible rules.

medlogix® serves as the differentiator that consolidates and intelligently shares these rules and outcomes across services to produce consistent, defendable outcomes with outstanding ROI for the medical claims management industry.

Audit Manager
Manages threshold rules to drive clinical reviews for proper bill documentation and causal relationship within medical bill auditing.
Benefits Manager
Allocates and deallocates patient deductibles, co-pays and policy limits after medical bill review. Supports the sharing of deductibles and co-pays across multiple injured parties as regulated by state guidelines. Enforces overall policy limits for individual claims and calculates late interest payments to providers and facilities for overdue bills.
Bill Negotiation Manager
Manages threshold rules to drive the negotiation of out-of-network bill negotiations. Contains historical negotiation results by provider to maximize current negotiations.
Bill Review Manager
Encompasses a complete set of cost containment rules to enforce during medical bill review. Additional rules based on the outcomes of almost every CSG service and associated manager is also seamlessly integrated as part of the bill review manager.
Care Plan Manager
Captures all information related to a pre-certification request. Analyzes current and past claims activity to present in a user friendly research tool for capturing medical director review decisions and rationale. These medical decisions are used to auto-adjudicate bills during medical bill review.
Case Manager
Manages all the outcomes derived from our field case management, telephonic case management and large case management services to utilize within the utilization management, pre-certification and medical bill review services.
Communications Manager
Similar to email, except secure and tightly integrated into the history of the claim, the communications manager provides a mechanism for CSG and clients to communicate about the workflows of daily claims management. Messages can be acknowledged and answered when appropriate. The communications manager can also send emails that link directly to medlogix® internal messages.
CPT Rule Manager
Allows for system and/or client-specific rules to be created for CPT codes to be either auto-adjudicated during medical bill review or flagged for comprehensive nurse code review.
Diagnosis Manager
Tracks all diagnoses related, unrelated and pending determination to establish proper causality for accurate pre-certification and medical bill review - supports both icd-9 and icd-10.
Document Manager
Organizes claim documents from all services by type, provider, specialty and date. Supports uploading new documents and downloading existing documents into organized packets of information optionally including fax receipt confirmations.
FROI Manager
Manages the first report of injury from initial triage through provider scheduling, follow-ups and eventual state regulatory reporting as required.
Pharmacy Manager
Prospective, concurrent and retrospective pharmacy benefit management to control drug costs within medical bill review.
PPO Manager
Manages access to CSG's own CHN PPO Network as well as access to more than 725,000 providers nationally through CSG's affiliated partner networks.
Professional Review Manager
Captures all information related to scheduling and securing IME and peer review outcomes. Outcomes are loaded into the Utilization Review Manager for auto-adjudication during medical bill review.
Provider Analysis
Analyzes historical provider data captured during medical bill review. Data is ranked in over a dozen categories to reveal critical insights and trends that may be related to suspicious and potentially fraudulent activity. This tool also compares providers against their peers to see how they rank in numerous categories.
Provider SIU Manager
Supports the ability to designate a Provider as under review by a Special Investigation Unit for possible fraudulent or other suspicious activity. Client-specific rules control how services are then handled during pre-certification and medical bill review.
Report Manager
Robust data warehouse techniques unify all claims data and service outcomes to deliver all the information you need quickly and easily. Assures that all state regulatory reporting guidelines are satisfied. Access numerous reports in several easy to use formats within the following categories:
  • Analytics
  • Compliance
  • Outcomes
  • Production
  • Regulatory
Utilization Review Manager
Consolidates outcomes from IMEs and peer reviews to auto-adjudicate bills during medical bill review.
Workflow Monitor
Shows every job currently active from all services organized by client, process, status and age. Includes interactive drilldowns into real time user activity.

  Security

medlogix® utilizes industry standard encryption and security practices to secure data both at rest and in transit. medlogix® Online provides a secure messaging system allowing clients to securely communicate with CSG without the need for encrypted email. CSG has partnered with Sword & Shield Enterprise Security and Agility Recovery Services to provide industry leading Security, Risk Management, Disaster Recovery and Business Continuity programs. medlogix® and CSG are both HIPAA compliant.

  Accessibility

medlogix®Online is the secure web portal for clients to access and interact with all CSG services. New services may be initiated with just a few clicks. Dashboards and inboxes allow both managers and claims representatives to easily monitor the status and outcomes of all services. Numerous industry leading tools provide the insight required to manage the complexities of today's claims.

  Experience

Hundreds of clients from small municipalities to large national carriers have selected CSG and medlogix® to be their business partner of choice for their claims management needs. CSG has imported millions of records and years of claims data from every major vendor and numerous in-house systems. CSG has an experienced team of developers, DBAs, analysts and project managers to handle any size conversion, integration and/or implementation.