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The MyMedlogix™ platform: created by a team of experts to deliver the very best.
Designed by leading developers, insurance professionals and healthcare specialists—only MyMedlogix offers this comprehensive suite of software applications specifically designed to improve decision making, maximize efficiencies, increase ROI and enhance outcomes in medical claims management.
Our solution is secure, flexible, scalable and robust and seamlessly integrates the latest regulatory guidelines, medical best practices and business-partner interfaces. Plus, all modules include capabilities to fully integrate with any claims system—standard or proprietary.
Powerful, built-in features
Jobs & Tasks drive inboxes with access controlled by user roles – monitors inventory & efficiency.
Customizable rules drive automation and ensure consistency.
Electronic data interfaces for eReferral, eData, eImage, eInvoice, ePPO.
Integrated incoming & outgoing with confirmation receipts.
User supported uploading & downloading of images with full document research & management.
Software intelligence handles rule sharing and outcomes.
Research and analysis functions provide valuable insight into claim and provider activity.
- Claim Summary
- Provider Analysis
- Care Plan Summary
Automated rules and checks assure the highest possible quality.
Easy, secure, anytime access with the MyMedlogix® online web portal with dashboard interface.
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Manages threshold rules to drive clinical reviews for proper bill documentation and causal relationship within medical bill auditing.
Allocates and deallocates patient deductibles, co-pays and policy limits after medical bill review. Supports the sharing of deductibles and co-pays across multiple injured parties as regulated by state guidelines. Enforces overall policy limits for individual claims and calculates late interest payments to providers and facilities for overdue bills.
Bill Negotiation Manager
Manages threshold rules to drive the negotiation of out-of-network bill negotiations. Contains historical negotiation results by provider to maximize current negotiations.
Bill Review Manager
Encompasses a complete set of cost containment rules to enforce during medical bill review. Additional rules based on the outcomes of almost every Medlogix® service and associated manager is also seamlessly integrated as part of the bill review manager.
Care Plan Manager
Captures all information related to a pre-certification request. Analyzes current and past claims activity to present in a user friendly research tool for capturing medical director review decisions and rationale. These medical decisions are used to auto-adjudicate bills during medical bill review.
Manages all the outcomes derived from our field case management, telephonic case management and large case management services to utilize within the utilization management, pre-certification and medical bill review services.
Similar to email, except secure and tightly integrated into the history of the claim, the communications manager provides a mechanism for Medlogix® and clients to communicate about the workflows of daily claims management. Messages can be acknowledged and answered when appropriate. The communications manager can also send emails that link directly to MyMedlogix™ internal messages.
CPT Rule Manager
Allows for system and/or client-specific rules to be created for CPT codes to be either auto-adjudicated during medical bill review or flagged for comprehensive nurse code review.
Tracks all diagnoses related, unrelated and pending determination to establish proper causality for accurate pre-certification and medical bill review – supports both ICD-9 and ICD-10.
Organizes claim documents from all services by type, provider, specialty and date. Supports uploading new documents and downloading existing documents into organized packets of information optionally including fax receipt confirmations.
Manages the first report of injury from initial triage through provider scheduling, follow-ups and eventual state regulatory reporting as required.
Prospective, concurrent and retrospective pharmacy benefit management to control drug costs within medical bill review.
Manages access to CHN PPO Network as well as access to more than 725,000 providers nationally through Medlogix® PPO affiliated partner networks.
Professional Review Manager
Captures all information related to scheduling and securing IME and peer review outcomes. Outcomes are loaded into the Utilization Review Manager for auto-adjudication during medical bill review.
Analyzes historical provider data captured during medical bill review. Data is ranked in over a dozen categories to reveal critical insights and trends that may be related to suspicious and potentially fraudulent activity. This tool also compares providers against their peers to see how they rank in numerous categories.
Provider SIU Manager
Supports the ability to designate a provider as under review by a Special Investigation Unit (SIU) for possible fraudulent or other suspicious activity. Client-specific rules control how services are then handled during pre-certification and medical bill review.
Robust data warehouse techniques unify all claims data and service outcomes to deliver all the information you need quickly and easily. Assures that all state regulatory reporting guidelines are satisfied. Provides access to numerous reports in several easy to use formats within the following categories:
Utilization Review Manager
Consolidates outcomes from IMEs and Peer Reviews to auto-adjudicate bills during medical bill review.
Shows every job currently active from all services organized by client, process, status and age. Includes interactive drilldowns into real time user activity.
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MyMedlogix™ utilizes industry standard encryption and security practices to secure data both at rest and in transit. MyMedlogix™ provides a secure messaging system allowing clients to securely communicate with us without the need for encrypted email. Medlogix has partnered with Sword & Shield Enterprise Security and Agility Recovery Services to provide industry leading Security, Risk Management, Disaster Recovery and Business Continuity programs.
MyMedlogix is the secure web portal for clients to access and interact with all Medlogix services. New services may be initiated with just a few clicks. Dashboards and inboxes allow both managers and claims representatives to easily monitor the status and outcomes of all services. Numerous industry leading tools provide the insight required to manage the complexities of today’s claims.
Hundreds of clients from small municipalities to large national carriers have selected Medlogix to be their business partner of choice for their claims management needs. Medlogix has imported millions of records and years of claims data from every major vendor and numerous in-house systems. Medlogix has an experienced team of developers, DBAs, analysts and project managers to handle any size conversion, integration and/or implementation.