Claims Administration

Adopt tech-driven claims management processes to optimize resources, manage scalability and reduce costs.



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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

A bar graph icon in a downward trend illustrating a reduction in cost associated with claims management.

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.

Scale icon balancing people and money representing the scalability of claims administration solutions.

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.

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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.

Icon with money, time and gears all working together to automate claims processes to improve turnaround times.

Improve Turnaround Time

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

Gears and growing bar chart icon showcasing an improvement in auto-adjudication rates using claims management software.

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.

How to Manage Claims Volume Surges Without Losing Performance

Learn how healthcare payers and TPAs can manage claims volume surges using automation, predictive analytics, scalable staffing, and real-time monitoring.

Claims Management Across the Complexity Spectrum: A Payer's Guide to Low, Medium, and High-Touch Cases

Learn how payers and TPAs manage low-, medium-, and high-complexity healthcare claims using tailored workflows, automation, and expert review.

5 Steps to Identify and Eliminate Duplicate Claims in Healthcare Claims Management

Learn how payers and TPAs can reduce duplicate claims caused by provider resubmissions, system errors, and data entry mistakes through validation and review processes.

Common Claims Processing Errors That Slow Payer Operations

Learn how claim rejections, coding mistakes, incomplete submissions, address errors, and member mismatches create delays and increase administrative costs for payers.


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