Services

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HEDIS

Working for six years now with Anthem Blue Cross, Medlinks Staffing continues to provide nearly 100 remote (work from home) and on-site staff to provide complete HEDIS chases including record retrieval or Pursuit of chases. We provide record Abstraction, record Research including re-opening chases for measure compliance, and record Overread for total compliance. Our 32-seat call center has dual monitors, VoIP phones for data collection and our one and only in the industry Productivity and Quality tracker. Our HEDIS Tracker uses a variety of data points to capture what your staff is doing and ensures meeting goals.

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Clinical Appeals

Medlinks Cost Containment, Inc. has provided hospitals and payers with expert analysis of claims and their corresponding need for the clinical appeal. Whether generating an original appeal or defending one, Medlinks track record for clinical appeals done by both our nurses and physicians has a stellar win rate. Our belief is in a model of education and feedback to the payer/provider to give both parties the tools to connect on a process, standards, and national billing and coding guidelines. Our clinical appeals team provides Medical Necessity, Level of Care, DRG Validation, Technical Denial and much more.

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Defense Auditing

As our core service Medlinks Cost Containment has saved our hospital and payer clients millions of dollars by containing costs through “smart” audit practices. The value of auditing claims is often overlooked and Medlinks will bring first, clarity to your process, and then the much missed follow through to resolve billing and documentation errors.

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Payment Integrity Services

Medlinks Cost Containment, Inc. provides Payment Integrity Services to payers. This is part audit, part negotiation of claims. This service would allow for a two-pronged approach to cost containment. First, it would be an outside view of EVERY claim submitted. This claim submission review frankly gives us a great starting point for discussion on:

  • Billing
  • Contract Negotiation
  • Coding
  • Cost Tracking
  • And much more

It allows Medlinks and you, the client, to define what you will pay for and why. This type of review very often nets dollars and you only pay when a claim is reduced.

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Medlinks Staffing, LLC

MSLLC is the daughter offshoot of MCCI. Together we can

provide a wide spectrum of services such as:

  • Executive Recruitment
  • Temporary Employment in the areas of Healthcare/Administration/ Business Office/Information Technology
  • Staff Recruitment
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The release of Information

For many of our clients we manage both sides of the release of information. The release of information or records requests is a specific design associated with maximizing your effort to contain costs. Knowing what to ask for, following up on that request can be a daunting task based on scale. Medlinks uses the Healthcare Audit Tracker to initiate and follow up on these requests assuring you have the records you need in time to take steps if needed. With the multitude of ambiguous requests out there, many clients leave the task of interpreting these requests for records to a junior staffer often not qualified to know what they’re releasing and to whom. Don’t Take Risks with your PHI.

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Contract Negotiation Consultation

Payers and providers can greatly benefit from contract negotiation. In the specific area of auditing and appeals Medlinks has offered specific consultation to both payers and providers to maximize the reach of auditing and to create a limit environment where all claims can be reviewed without hurdles.

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Comprehensive Audit Policy

Medlinks has provided many clients with their “Audit Policy and Procedure” document. To our surprise, many institutions have a limited policy in terms of auditing or none at all. An audit policy dictates your workflow and parameters and can be invaluable in contract negotiations, payer/provider communication, appeal processes and the like.

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Call Center

Located in Antioch, California on Pacific Standard Time, our call center has 32 seats, with PC's, dual monitors, VoIP, and Project management staff. Our office can do sales, scripted calls, specialty follow up, education, political outgoing and a variety of other calls. Our record with HEDIS projects continues to break records.

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Denied Claim Resolution

Denied claims have many reasons many of which can and should be appealed. Medlinks expert staff of MD’s and RN’s have had great success in reversing these trends.

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Workers Compensation Claim

WCC claims can be tricky. Their propensity leans heavily towards denial. Our experts can set a precedence towards paying claims for the life of the claim.

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Out of State/Country/Network

Out of state/country/network presents a number of challenges. We can help or independently navigate these difficult claims for your benefit.

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Liability and Lean

Liability and lean can be long fought battles. Let us get these tough to adjudicate claims paid.

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Medicaid Eligibility

Medicaid eligibility is a formal legal process. Correctly processing can be crucial. Let our experts manage this task for you.

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Credentialing

Credentialing is a critical part of your sites liability concerns. Make sure credentialing is up to date and correct..

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Zero Balance Audits

In 2013, 7% of paid medical claims had errors, according to the most recent data from the American Medical Association. Denied claims averaged about 5% that year, the AMA found. Insurers today are focusing more on prior authorization and medical necessity. Benefits are more restricted and carve-outs for services such as behavioral health are more common. More services are subject to deductibles, and in-network and out-of-network coverages are harder to track. Providers must navigate a maze of complex revenue cycle processes, including proper patient identification, registration, authorization management, service documentation, charge capture, coding, billing, and follow-up. We can absolutely help and our data analytics and educational follow up will increase reimbursement and contain costs.

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Outlier Overpayment Recovery

Outlier payments are a specialty review worthy of time, effort, and expense. Let our experts get you paid.

Choose Your Plan

Choose Your Plan

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