The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans.
The MedLink Difference
The MedLink Claims Review system electronically reviews or “scrubs” the clinical information and charges on medical claims – both institutional and professional – and identifies coding errors and billing mistakes… even after other scrubbing processes have already been utilized. The MedLink Claims Review difference is our Scrubbing Engine: our engine is the most in-depth and clinically comprehensive in the marketplace today. Our vast knowledge stems from years of experience working with employer plans, physicians, hospitals and other health providers on documentation, coding and billing accuracy. Our working knowledge and insight includes payer practices, medical standards of care and reimbursement.
MedLink edits were developed by a team of health care coding and billing specialists with decades of experience working as consultants to providers on medical documentation, coding and billing. When needed we access double-certified coders who know the nuances of medical coding, and we’ve spent decades helping providers get their bills correct before submitting them for payment. The extensive working knowledge and insight with coding standards, clinical practice and medical necessity, as well as medical billing and payer practices, have gone into the development of the MedLink Claims Review edit rules and scrubbing engine.
MedLink has scrubbed behind top health insurance carriers as well as other code editing vendors and off-the-shelf box products. In every case, MedLink has identified a range of 5% to 8% or more in overpayments from coding and billing errors when work-comp is included in the mix. By finding errors others miss, we save self-funded clients tens of thousands of dollars in provider overpayments per million in claims. We do all the review and appeals work. The Employer Self-Funded Plan enjoys the recovery of overpayments.
MedLink scrubs claims prior to sending to payers on behalf of the provider using the same rules so the provider knows what to expect with regard to reimbursement. This expectation is in sync with the payer since the tools are the same. As a result practices have saved significant amounts of time processing claims and reduced the underpayments due to coding and billing errors. By finding errors billers miss, we save providers tens of thousands of dollars in underpayments per million claims.