Claim Administration | MDI NetworX

Are you looking to improve your claims management processes?

Quick turnaround times and enhanced claims management is critical to gaining a competitive edge in the healthcare insurance marketplace. Our commitment and confidence to provide outsourced Claim Administration services to the US Payers and TPAs comes from our propriety frontend claims management tool, Golem and performance and resource management tool, InsightPRO. We work with our clients to develop custom rules and automated workflows as per their 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 end-to-end support for the entire claims process - from receipt (paper or EDI) through scrubbing, member/provider matching & verification, 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 solution, your company’s claims processing needs are handled responsibly:

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

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 claims administration service offers you a customized solution that adapts to your evolving needs. Scale rapidly with an increase in demand without investing 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 propriety algorithms help you have better provider & member matching before the claims are evaluated for auto adjudication rules, thus 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

Optimizing your claims processing in five easy ways

One of the biggest truths in claims processing is that the faster you deliver claims resolution, and the quicker you are to respond to inquiries, the happier your policyholders will be.

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.

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.

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