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Solutions:
TPA Service
Third Party Administration
Services are available through MedAdmin Solutions,
Inc., an eHDL company.
MedAdmin Solutions, Inc offers comprehensive, high
quality Administrative Services for Managed Care Organizations
and Self Funded/Employee Benefit Organizations.
Experience The Difference!
- Low entry cost for service – Pay
as you go
- Produce revenue opportunities for current
clients
- Business and Electronic Links between
Payers and Providers
- Real-time information that reduces risk
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Health Maintenance Organizations
(HMO’s)
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Independent Practice Associations
(IPA’s)
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Insurers
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Management Services Organizations
(MSO’s)
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Physician-Hospital Organization
(PHO’s)
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Self-Funded Employers
Claims Adjudication
& Encounter Processing
- Claims Adjudication and Encounter Administration
for contracts in Self-Funded Employee Benefits and
Managed Care settings
- Identify and manage billing errors, unnecessary
services, and disallowed charges
- Receive and process Claims in many formats
Capitation Payment Processing
& Management
- Builds Contract Management for complex Capitation
Payment models
- Manages reimbursement arrangements and fee schedules
for various Providers and Payers – Fee For
Service, Withholds, Per Diems, and Case Rates
Member Eligibility & Benefit
Administration
- Maintains Membership and Benefit Information by
Plan
- Electronic, HIPAA-Compliant EDI transactions available
to Providers
Placement of Reinsurance Coverage
- Competitive Rates for Reinsurance due to strong
buying power
- Manage Reinsurance Payouts
Medical and Case Management
System
- Established Clinical Criteria administered by
Nurses and Physicians
Data Analysis and Reporting
- Capitation and Utilization Analysis
- Member Satisfaction Reports
- Provider Profiling
- Network Composition Analysis – Geo-Coding
- Outcome Reports for Benefit and Plan Analysis
- Longitudinal Studies associated with Enrollment,
Utilization, Clinical, IBNR, and financial Management
Call Center and Customer Service
Operations
- Trained Customer Service staff and management
- State-of-the Art Customer Relations Technology
- Provider Reimbursement Management
- Billing and Premium Collections
- COBRA and HIPAA Administration
- Flex-Benefit Administration
- Utilization Management, through Referral and Authorization
Tracking
MedAdmin Solutions, Inc.
Providing Information Systems and Administrative Services
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