Who We Are
Medlinks Cost Containment Inc. was created in 1997 as a resource for medical professional institutions to outsource their billing, abstracting, auditing, coding, staffing, revenue cycle solutions, auditing, trauma abstraction and a host of other services helping hospitals and commercial payers resolve issues in their Revenue Cycle.
Since our inception we have served a wide variety of clients including law practices, private physicians’ practices, large hospital organizations, and the nation’s biggest payers. Some of our clients include: Anthem Blue Cross, Sutter Health, Sharecare, Stanford Health, New West Health, John Muir Health, Washington Hospital health Systems, Moses – Cone Health, Equian.
Our associates, subcontractors, vendors, and channel partners have a wide variety of experience both within and outside of the healthcare industry. We have a modest, honest approach to your project resolution. We use Claim WRX™, The industry’s leading Denials Management Solution and Audit Tracking System. The application was meant to to contain costs in Denials Management, and then using a reporting methodology, we begin defining at ever increasing granular levels, the “root cause” of your denial and its ultimate resolution.
Our proprietary SaaS cloud-based workflow tool intended for the many types of “audits” that occur within the industry. As this is our primary source of business, we are very familiar with the needs and shortfalls many companies experience in this realm. To be frank, we have a better solution for the quick and concise review, and data tracking of audits. Because we are cloud based you can audit from your laptop, tablet, or even phone and Claim WRX surpasses all the standards set by HIPAA-HITECH. We offer all types of medical audit, virtual 24/7 case management, trauma abstraction, and a wide variety of revenue cycle solutions.
Claim WRX Features:
- Easily manage audits from the Letter of Intent to Audit (LOI) through adjudication
- Track all aspects of audit stages from pending to closed and every stage in between
- Synchronizes seamlessly with Outlook HIPAA-HITECH Compliant Cloud Based Rich reporting ability
- Tracks error rates by department or even by single line item
- Track RAC and other government compliance audits including attaching the entire medical record
- Create clinical appeal letters and track their denial “root cause”
- Create and defend DRG/APC claims
- Defend (all types) of coding denials
- Comes with built in business logic, and rich reporting for granular interpretation delivered monthly
- Virtual 24/7 Case Management Third Party Appeals Tablet/Smart Phone Compatible Dramatically reduces audit workflow time
- Built by auditors for auditors
- Possible to suggest and add new features based on your needs
- Simplified audit scheduling with automated process flow and opposing auditor invite and updates
What other solutions or services does Medlinks offer?
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 Over read 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.
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.
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.
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:
- Contract Negotiation
- 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.
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
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.
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.
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.
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.
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.
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.
Out of State/County/Network
Out of state/country/network presents a number of challenges. We can help or independently navigate these difficult claims for your benefit.
Liability and Lean
Liability and lean can be long fought battles. Let us get these tough to adjudicate claims paid.
Medicaid eligibility is a formal legal process. Correctly processing can be crucial. Let our experts manage this task for you.
Credentialing is a critical part of your sites liability concerns. Make sure credentialing is up to date and correct
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.
Outlier Overpayment Recovery
Outlier payments are a specialty review worthy of time, effort, and expense. Let our experts get you paid.