Empowering US Healthcare Payers to streamline claims processing

MDI NetworX empowers business transformation by functioning as your trusted healthcare claims processing and adjudication service partner to streamline business processes for improved efficiency and customer experience. Our futuristic technology-enabled and insight-driven approach with a skilled manual workforce enables us to optimize existing procedures, enhance processing quality and accuracy, and reduce the turnaround time while our clients focus on other core competencies.

The rising administrative costs and operational complexity in claims adjudication across the US healthcare payer industry have induced demand for a more efficient end-to-end process. 

Are you already swamping with a claims backlog? Is your in-house staff capable of handling all the adjudication demands without costing productivity? Are they competitive enough to eliminate fraud claims with falsified data? 

Struggling with inefficient claims processes, lack of competitive in-house resources and outdated technology result in huge claims backlog, which often translates into a member and provider dissatisfaction. Duplicate and fraudulent medical claims cost payers billions of dollars. Even the smallest data errors, discrepancies, or duplicates may result in unwanted delays or denial of claims causing huge monetary and reputational losses to the payers. 

Today, the US healthcare payers are looking for a robust, less time-consuming, and error-free claim processing and adjudication solution to reduce eliminate their administrative burdens and achieve faster settlements while reducing the total turnaround time to gain a competitive edge in the market. Healthcare payers need outsourcing partners who can ensure quality and accurate claim processing and lower healthcare cost & time per claim—all while being capable of scaling up operations during processing peaks. 

Outsourcing MDI NetworX’s comprehensive, technology-enabled claim adjudication service is just the solution you need to optimize and transform your claims processing system.

Sometimes, your setup might be struggling for accurate claim adjudication. Time is also an important factor here.

MDI NetworX recognizes the importance of timely and accurate claims adjudication. We work to support and optimize your overall claims adjudication strategy with user-defined rules providing the best-practice workflows, AI-enabled technology, and skilled workforce support. Adopting this proactive approach enables us to deliver a robust, error-free, and time-efficient claims processing and adjudication solution that can streamline your claims operations by addressing inefficiencies across the entire lifecycle right through claim submission and data entry to adjudication and payment.

Leveraging our deep domain expertise in the healthcare industry, our well-structured, comprehensive claim adjudication service helps to alleviate the various pain points and penalties associated with claim errors and time-consuming manual processes. Our team of skilled and experienced manual adjudicators are trained on multiple plan types and adjudication platforms to process a wide variety of claims based on the US healthcare reimbursement models.

Elevate Accuracy. Reduce Expenses. Boost Productivity. 

MDI NetworX’s foolproof claims adjudication solution assists payers to efficiently deal with fraudulent claims, duplicate claims, erroneous data, etc. mitigating operations costs, increasing productivity, and boosting revenue. We can provide our clients with a unique competitive advantage with a scalable claims processing solution to meet higher processing demand during peeks. 

We are committed to providing healthcare payers to deliver a well-coordinated, cohesive, and affordable healthcare experience. Our clients have achieved significant healthcare adjudication benefits in terms of cost, time, and accuracy using our proprietary workflow management tool, DocGem, in combination with a highly skilled team of adjudicators. 

What sets us apart from other medical claim adjudication providers? 

• Improved processing cost per claim
• Improved accuracy through robust QA processes
• A highly-trained, skilled team of claim adjudicators
• AI-enabled workflow technology
• Reduced time spent working on pended claims
• HIPAA compliant
• Faster turnaround time

With over 20+ years of experience in managing US healthcare accounts for both payers and providers, our core team at MDI NetworX has successfully transitioned 100+ claims processes in the US. We have expertise in processing all types of healthcare claim forms, including CMS1500, UB04, dental claims, Rx claims, Medicaid,  pends/correspondence, foreign claims, and many more. We have dedicated teams to manage claims from different Line of businesses (LOBs) i.e. Medicare, Medicaid, Tricare, Commercial, Subrogation, Workers compensation, and others for our US-based clients.

Put an end to claim processing issues. Choose MDI NetworX claim adjudication services today!