Solutions For:
 






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

  • Health Maintenance Organizations (HMO’s)
  • Independent Practice Associations (IPA’s)
  • Insurers
  • Management Services Organizations (MSO’s)
  • Physician-Hospital Organization (PHO’s)
  • 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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