Third Party Administration Services are available through MedAdmin Solutions, Inc., an eHDL company.
MedAdmin Solutions offers comprehensive, high quality Administration Services for Managed Care Organizations, Self-Funded/Employee Benefit Organizations, Health Insurance Companies, and various other organizations requiring specialized administrative services.
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 (electronic, paper, portal, etc.)
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
Maintains Membership and Benefit Information by Plan or Group
Electronic, HIPAA-Compliant EDI transactions available to Providers
Competitive Rates for Reinsurance due to strong buying power
Manage Reinsurance Payouts
Claims Audit services for unique reinsurance or stop-loss arrangements
Established Clinical Criteria administered by Nurses and Physicians
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
Trained Customer Service staff and management
State-of-the Art Customer Relations Technology
Provider Reimbursement Management
Billing and Premium Collections
COBRA and HIPAA Administration
Utilization Management, through Referral and Authorization Tracking
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