MDI NetwroX

Overview

Metallaso, a PPO routing and repricing application can help users efficiently re-price claims. Metallaso uses the automatic workflow and PPO routing rules engine to apply simple or complex routing rules and spontaneously route claims to and from multiple level PPOs for repricing services, thereby providing repriced claims to the payer that can be further routed for adjudication.

The complete process runs smoothly without any manual intervention. The system further offers complete transparency in form of reports and dashboards to help the user to know the exact status of the claim in real-time.

Advantage

Achieve Greater Efficiency

Increase efficiency by automatically routing claims to and from PPOs / Non-PPOs.

Reduce Turnaround Time

Significantly reduce time lag for repricing claims and move claims faster to auto-adjudication.

Optimize Operational Cost

Improve processing cost-per-claim by reducing manual intervention.

Automatic Notifications

Send automated notifications to highlight the aging claim or a claim that is in the network for more than expected timeframe.

Manage Complex Rules

Handle more complex rules that revolve around, DOS, form type, service location or dollar amount. Also, apply other required rules after repricing and before sending to the payer based on TIN.

Real Time Tracking

Track real time inbound and outbound connections / file transfers with the trading partners.

Features

MDI Modeler is an advanced analytical platform that reduces time and effort associated with contract analysis and provides greater insight and flexibility in provider negotiations. Key features are as follows:

Integration With Trading Partners

Integration with trading partners for rapid, seamless, and accurate movement of the claims.

Multiple File Types

Support for all file formats, including electronic (.edi) and non-electronic (.txt, .csv, .xml, .xlsx) for repricing.

Single Repository

Eliminate paperwork and store all claims repricing data in one location.

Routing Rules Engine

Highly configurable business rules engine coupled with member and provider matching, helps determine the member and provider networks.

Network Hierarchy

Multi-level PPO Routing configuration for easy setup of primary, wrap, and tertiary network. Based on the setting the system routes claim across the hierarchy. Built in connections with 200 different PPOs, RBPs and Bill Review Entities.

Scalable Workflow

Easy, configurable, and scalable workflow to consolidate or automated your existing processes.

Audit Trail

Complete audit trail to easily track the claim status in real time.

Dashboards & Analytics

Better insights into complete PPO routing process including inbound and outbound connections.

Metallaso