MDI Network

Claims Management

Overview

MDI NetworX has extensive experience of providing outsourced Claim Management services to Payers, TPAs globally. We do this specifically by:

  • Employing our claims management software (Golem) and working with our clients to develop custom rules and workflows as per their specific needs.
  • Allowing our trained claims processors and analysts to provide manual support to handle exceptions (non-auto adjudicated cases).

Our associates are trained to provide end-to-end support for entire claims process, from receipt (paper or EDI) through member/provider matching & verification, scrubbing, adjudication and adjustment.

MDI Advantage

MDI Network

Reduce Cost

MDI Network

Manage Scale

MDI Network

Optimize Resources

MDI Network

Improve Turnaround Time

MDI Network

Improve Auto-adjudication Rate

Capabilities

MDI’s existing highly scalable infrastructure, adjudication know-how, and proven capability to process all types of claims (e.g. CMS1500, UB04, Rx, Dental and all Non Standard Claim forms) can provide a comprehensive outsourced solution for your company’s claims processing needs.

Adjudication process is as follows

  • Receipt of a paper or EDI claim
  • Patient and provider validation
  • Eligibility confirmation
  • Re-pricing
  • Claim cleanup and de-duplication
  • Application of custom rules/routing (e.g. custom flag actions, unique documentation requirements)
  • Adjudication (Approval, Denial, Pend)
  • Audit support and Reporting

01 MEMBER / PROVIDER MATCHING

The Challenge of matching member/provider to ensure the accuracy of payment that has been a never ending concern for healthcare industry.
With MDI expertise in member and provider matching, your enterprise will experience significant improvement in accuracy of payments for the eligible members to the right providers, leading to reduction in errors and costs.

02 CLAIMS ADJUDICATION

Reducing the cost and time required to adjudicate the claim forms with minimal errors are key concerns for healthcare payers. MDI NetworX Claims Adjudication team is acquainted to work with multiple platforms, ensuring efficient claims processing, faster settlements and lower processing cost per claim thereby benefiting healthcare payers.

03 CLAIM ADJUSTMENT

MDI's Claims Specialists have a vast experience of handing different type of adjustments (E.g. corrected claim, duplicate payment, change in fee schedule, overlapping hospital bills, appeals, exception processing and benefit application)  

 

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