Group Health
Our strategic negotiation service is not a prompt-pay process that seeks small discounts from claims without first validating all charges. Qmedtrix’s Strategic Group Health Negotiation identifies excessive charges by incorporating public and private databases of national charged and paid data accumulated and continuously updated over our 14-year history. We integrate a physician-based understanding of claims review with the Qmedtrix BillChek® review service which provides:
- Fee analysis using historical payment data, and current public data to identify excessive charges
- Cost analysis for implants, supplies, pharmaceuticals, and various medical equipment
- Correct coding edits to detect unbundling, upcoding, and other inconsistent errors in billing that do not adhere to nationally recognized standards
- Diagnostic Related Group (DRG) validation
- Duplicate charge identification
Qmedtrix’s strategic negotiation process engages the provider with compelling dialogue that is based on a sound methodology supported with data specific to the jurisdiction. Our well-defined review process coupled with our professional negotiators is designed to obtain signed settlement agreements to prevent balance billing to the patient or member while paying providers fairly and reasonably.