Claims Administration: Tech-Driven Claims Management Processes

Are you looking to improve your claims management processes?

Quick turnaround times and enhanced claims administration management is critical to gaining a competitive edge in the healthcare insurance marketplace. Our commitment and confidence to providing outsourced claims administration services to US Payers and TPAs comes from our proprietary frontend claims management tool, Golem, and performance and resource management tool, InsightPro. We work with our clients to develop custom rules and automated workflows to meet your unique requirements. Our trained claims processors and analysts are always on standby to provide manual support for any exceptions other than non-auto adjudicated claims.

Leverage our end-to-end support for the entire claims process - from receipt (paper or EDI) through scrubbing, member/provider matching & verification, claims adjudication and adjustment - and leave your people free to focus on their core operational areas.

How We Make It Work

Reinvent your claims processing operations and improve efficiencies with MDI’s highly scalable infrastructure. We are always seeking to add to our adjudication knowledge, and our proven capability to process all types of claims (including CMS1500, UB04, Rx, Dental and all Non-Standard Claim forms) has proven successful for our clients.

With this comprehensive outsourced claims administration solution, your company’s claims processing needs are handled responsibly through:

Receipt of a paper or EDI claim
Patient and provider validation
Eligibility confirmation
Re-pricing
Adjudication (Approval, Denial, Pend)

Claim cleanup and de-duplication
Audit support and Reporting
Application of custom rules/routing (e.g. custom flag actions, unique documentation requirements)

MDI Advantage

Reduce Cost

We lower resource utilization and reduce costs associated with claims management. Our responsive and agile claims administration service will enhance customer service and your backend operations.

Manage Scale

Our healthcare claims management solution offers you a customized solution that adapts to your evolving needs. Now you can scale rapidly with an increase in demand without having to invest in additional resources.

Optimize Resources

The right blend of technology and human interface ensures your claims processes work seamlessly with minimal manual intervention, thus freeing up existing resources for more critical tasks.

Improve Turnaround Time

Automating your claims processes can rapidly improve turnaround time, and the resultant efficiency leads to better customer experiences.

Improve Auto-Adjudication Rate

Our proprietary algorithms help you have better provider and member matching before the claims are evaluated for claims auto-adjudication rules, resulting in increased auto-adjudication rate.

Discover New Insights

Take a moment to go through our resource section where our data-driven insights can help improve your operational efficiency.

Achieving 10x ROI: How Automation Transforms Claims Auditing and Member Satisfaction

Discover how automation boosts claims auditing productivity, reduces service calls, and enhances member satisfaction, delivering up to 10x ROI for healthcare payers.

Applying analytics, automation, and AI to minimize clinical denials

In recent times, payment methodologies have evolved significantly, however US payer continue to be plagued by claims denials.

Utilizing AI/ML can improve claims processing efficiency & the provider-payer relationship

One of the biggest challenges that healthcare organizations continue to grapple with is the payer-provider disparities.

Expediting claim processing with increased accuracy and less effort using OCR/ICR

MDI NetworX utilizes high-definition scanning in combination with OCR/ICR data capture technology.

View All Resources