MediLink’s extensive electronic network allows service providers to check member eligibility in a matter of seconds -- by scanning a QR code, verifying a card (chip or magnetic stripe), or inquiring via an online facility.Learn More
In cases when Payors require pre-authorization, MediLink provides escrow services to guarantee payments to Providers, while ensuring that services are rendered according to Payor-prescribed -guidelines, such as allowable conditions or benefit limits.Learn More
MediLink allows providers to submit claims electronically with a verified approval code. Thereafter, claims ae processed in accordance with the member’s health plan. Providers may electronically submit claims that are associated with an approval code. Claims are adjudicated using business rules and artificial intelligence algorithms to monitor and prevent fraud.Learn More
Prior to authorizing electronic payments, our decision support system confirms that the claims presented by providers fall within the member’s benefit limits. Thereafter, payments are settled with providers on behalf of payors. For transparency, the electronic proof-of-payment are visible to both the payor and provider through their respective online portals.Learn More
MediLink’s analytics services are used by our clients to gain insight on utilization from a variety of dimensions (e.g., member demographics, industry, geography, provider level, type of service, clinical diagnoses, clinical procedures, etc.)Learn More
In addition to rules, MediLink employs a variety of machine learning techniques to identify suspicious patterns and detect potential fraud. Suspicious transactions are investigated and once verified as fraud, the knowledge is used to refine the algorithms.Learn More
Most healthcare insurers employ allied health professionals for back office functions such as claim pre-authorization and adjudication. However, staffing is problematic as these professionals’ first preference would be to work in a clinical setting, as these provide stepping-stones for overseas career opportunities.
A leading health insurer uses big data analytics to detect fraudulent claims. Implementing both rule-based and probabilistic algorithms revealed that 12% of claim amounts seemed very suspicious. This translates to potential savings when the same method is incorporated in the decision support system.