MedRx360 delivers proven
Payment Integrity
solutions for all Payers
MedRx360 provides unique and proven Payment Integrity solutions for payers of Medicaid, Medicare, Commercial, Self-Funded, Workers Comp, TPA & Union claims. Specializing in the retrospective validation and recovery of overpayments, we improve health plan financial performance while ensuring that government and industry payment policies are adhered to.
SOLUTIONS:
MedRx360 provides unique and proven Payment Integrity solutions for payers of Medicaid, Medicare, Commercial, Self-Funded, Workers Comp, TPA & Union claims. Specializing in the retrospective validation and recovery of overpayments, we improve health plan financial performance while ensuring that government and industry payment policies are adhered to.
Payment Accuracy
Coordination of Benefits
Medical Pharmacy
Web Based Application
Consulting & Outsourcing Solutions
Payment Accuracy
- Extensive proprietary Algorithms to quickly detect likely overpayments.
- All claims individually validated – no extrapolation
- Payment policies enforced include CMS Medicare/Medicaid, Commercial & all Industry standard rules and edits.
- Typical validations include NCCI, Duplicates, Contract compliance & DRG.
- Hospital Bill Audits: onsite audit of bill vs medical records using R.N.’s.
Coordination of Benefits
- Also known as Third Party Liability or TPL.
- For all Lines of Business.
- Verified other coverage information for your members.
- Upon Overpayment validation we offer recoupment services.
Medical Pharmacy
- Drugs paid as health plan benefit (JCodes).
- Pre & Post Payment Solutions.
- NDC Crosswalk & Conversion – to prevent unit errors.
- Pricing – Up to date AWP, WAC, ASP & APC.
- Min/Max/MUE – Allowable dose per CMS & FDA.
- Dosing & Wastage Calculator.
- Our Solutions result in 20%-40% in savings.
Web Based Application
- Web based end-to-end recovery application.
- Includes All Functions – Data Analysis, Audit, Validation, Collection.
- Module for loading Provider Contracts
- Management Reporting for status & results.
- Generate collection letters automatically and track recoveries.
- Eliminate use of spreadsheets for efficiency and PHI.
Consulting & Outsourcing Solutions
- MedRx360 leverages decades of industry experience offering tailored consulting services for health plans. Our scope includes Provider Contracting, Reimbursement Methodologies (Fee for Service, DRG, Capitation), Drug Formularies, 340B programs and much more. Contact us to discuss your needs.
- MedRx360 has the capabilities to facilitate a partial or full outsource of your Financial Recovery department by leveraging our extensive technology assets and expert audit & recovery team.
MARKETS:
MedRx360 Payment Integrity solutions are ideal for all type payers. For over 17 years, our management and audit team have recovered “lost funds” for payers of Medicare, Medicaid, Commercial, Self-funded, TPA and Union claims.
Serving
U.S. & Latin America
MedRx360 is the only Payment Integrity firm with both U.S. and Latin America presence with a fully bilingual team. Headquartered in San Juan, Puerto Rico, we work with U.S. and Latin American government and private health plans to deliver payment integrity and claim handling solutions.
