Strategic Bill Negotiation Services
Qmedtrix’s strategic negotiation is not a prompt pay process that seeks a discount off of the total billed charges. Instead, we review each bill to see if it accurately reflects the procedures and facility usage; based on that analysis, we determine the appropriate reimbursement.
Additionally, our process incorporates a physician-based understanding of medical bill review and analysis, supported by software and data elements to identify billing errors such as up-coding, unbundling, egregious mark-ups (e.g., implants) and medically unlikely events. The ‘corrected’ bill is then analyzed for overcharges based on public and private data sources accumulated and continuously updated over our 13 year history.
Qmedtrix negotiators talk with providers to arrive at a mutually acceptable reimbursement within the regulatory parameters or policy provisions that apply. A signed settlement agreement is obtained from the authorized provider representative to prevent balance billing to the payer, patient, member, or policyholder. This reasonable approach can be used for any coverage type and results in savings to the payer and fair payment to the provider.