Predictive Intelligence FAQs

Q. How will my historical claim and denial data load into Predictive Intelligence (PIQ)?

• Data loading: Xpeditor clients will have their data loaded into Quadax’s Electronic Data Warehouse (EDW).
• How Data Is Used: PIQ builds its models by accessing historical data. Nine months of data is used to train and test models (7 months training and 2 months testing).
• Frequency of model updates: Models are refreshed on a monthly cadence.

New to Xpeditor?
• If you are a client that is new to Xpeditor, old data (if available) can be loaded. A 10K record minimum is required, and 9 months of data is preferred for improved model performance.
• If you will not be loading old data, then 10K records is required, and 9 months of data is preferred for improved model performance, before using PIQ.

Q. Does PIQ monitor for claims at the payer level or plan level?

• Payer Level.

Q. What factors drive the expected reimbursement?

• The PIQ modeling is trained using various historical features on the claim (payer, encounter, and organizational attributes).
• PIQ will predict the expected reimbursement from a request based on previous volumes.
• Contractual data is not currently used.

Q. Will the Predictive values be available in the XpressBiller application so that I am able to customize and create my own rules?

• Yes, XpressBiller can be used in many ways for claim processing. You can write rules on payer rejects, denials and now with the new predictive values.
• Explainer:
1. XpressBiller rules can be considered when the likelihood to deny is determined.
2. PIQ processing occurs after the edits/converts process.
3. All ‘scrubbing’ is done prior to sending a claim to PIQ for scoring.

Q. How does PIQ leverage data? Is it from a third-party or Quadax designed?

• Quadax has an analytics team that includes data scientists who leverage advanced statistical tools (i.e., Machine Learning) to deploy PIQ.

Q. Will PIQ be used to sell my data to payers and other entities?

• No. All existing contractual terms apply.

Q. Can I hide this view from certain users?

• Yes, PIQ leverages EDI Product Licensing. The same functionality applies across all Xpeditor clients.

Q. Will PIQ need access to my payer contracts?

• No, not in the current iteration.

Q. What is the time and resources needed from our IT department to install PIQ?

• IT involvement is minimal, if any.
• Quadax will do the set up for the client and then train on how to leverage PIQ in the claim’s workflow and reporting.