Our Company
Logiqual is organized to effectively manage a wide variety of health care reviews and compliance activities across the country, including HEDIS® Compliance Audits, external quality review and encounter data validation services. By leveraging the extensive knowledge and expertise of talented staff at Logiqual and our affiliate company IPRO, Logiqual is able to deliver a broad range of integrated health care services. Logiqual, through its parent company, has twenty-five (25) years of health care auditing and data validation experience and an in-depth knowledge of the health care industry.
Logiqual assumed responsibility of IPRO’s HEDIS®, data validation and related consulting business in 2007 to satisfy a new regulation of CMS, which requires separation of External Quality Review Activities conducted on behalf of the State for Medicaid plans and compliance and validation audits. The management and staff of Logiqual have conducted HEDIS compliance audits nationwide for both the public and private sectors since the inception of the HEDIS audit program in 1997.
Logiqual enjoys a reputation as an industry leader in the area of auditing and data validation services. This can be largely attributed to the influential role our audit team played in the evolution of the HEDIS® audit program combined with the experience we have gleaned from successfully performing approximately 1,700 audits to date. The high quality of our auditing work has resulted in our contracts being renewed by our clients year after year. Since its inception, Logiqual has expanded its services to include but are not limited to:
- HEDIS® Consulting
- HEDIS® Medical Record Review
- CMS Medicare Part C and D Data Validation
- Encounter Data Validation
- Appeal Review
- Compliance Performance Review
- Physician chart audits for the Bridges to Excellence (BTE) Care Link Programs
- Pay-for-Performance Program (P4P) Audits
- State & Federal Regulatory Compliance Preparation
Logiqual is confident that our experienced staff will be able to deliver high quality services to our clients at a reasonable cost.
HIPAA Compliance
Logiqual maintains formal policies and procedures that are effective in protecting the integrity and confidentiality of the vast amounts of digital and printed customer data under LOGIQUAL’s control at any point in time. Logiqual’s security processes meet or exceed strict contractual, regulatory and professional certification standards. Logiqual maintains a robust HIPAA compliance program involving safeguarding of physical and digital data, limited data access, and ongoing employee training and awareness.
ISO-Certified Quality Management System
One of only a handful of similar organizations to achieve the distinction, Logiqual has been continually certified to the ISO 9000 family of quality management standards since 2007. These standards are published by the International Organization for Standardization to help companies ensure they meet the needs of customers and other stakeholders by implementing a formal, documented quality management system. Once certified, companies are subject to regular operational audits by an independent examiner. Logiqual is certified to the latest ISO 9001:2008 standard.
Our CEO
Eileen Scott, RN, CPHQ, CHC, CHCA
Logiqual’s CEO, Eileen Scott, a registered nurse, certified HEDIS® compliance auditor, certified healthcare compliance professional and experienced project director, is the HEDIS audit Project Leader. Ms. Scott oversees and manages an exceptional group of senior managed care professionals, each of whom possesses extensive experience in conducting HEDIS® compliance audits and related encounter data validation activities. Ms. Scott manages Logiqual’s business lines including HEDIS® Compliance Audits, CMS data validation audits, medical record validation, including quality improvement studies, and medical record abstraction projects.
Ms. Scott has ten years of prior experience as IPRO’s Senior Director of Planning, Quality and Compliance. In this role, she implemented and operated IPRO’s internal quality control audit program, and assured ongoing compliance with ISO standards. She also trained over 400 staff on federal privacy statutes and compliance issues, developed and enforced quality control policies and procedures, and oversaw audits of IPRO’s internal practices and procedures to assure adherence to contractual and regulatory requirements relative to conflict of interest avoidance and the safeguarding of PHI. She also served as a secondary compliance HEDIS® auditor as part of IPRO’s HEDIS® Audit Program of managed care plans in New York State.
Ms. Scott has participated in numerous HEDIS® Compliance Audits both as an auditor and as a quality assurance manager for a national managed care services organization, and has led and participated in managed care readiness and operational assessment reviews.
Ms. Scott’s management experience includes executing industry standard best practice methodologies for ensuring that projects are completed on time and within budget, using computerized tools and reporting mechanisms that are agreeable to the client. Ms. Scott is adept at creating and maintaining audit work plans, which serve as the foundation for all audit activities, and at communicating the status of all activities to the client on an ongoing basis.