AUTO MEDICAL

MyMedlogix® is our proprietary fully-integrated Medical Bill Review software through which all information is contained. Our proprietary technology creates a seamless, web-based platform through which all processes flow through one integrated system. With MyMedlogix, clients can efficiently and securely manage claim activities with real-time data 24/7. Most importantly, this platform meets all local, regional and national jurisdiction requirements.

MyMedlogix is a paperless workflow-based model that controls user access by role and provides a consistent monitored environment for all work.  The MyMedlogix integrated solution is a single system that allows the client to have a transparent mailroom, scanning and integrated data capture solution. MyMedlogix contains several robust rules engines that can be customized to support client-specific needs such as by coverage, location, adjuster, SIU, etc.

The MyMedlogix integrated solution allows us to reprice provider, facility and ancillary services bills while determining diagnosis relationship, medically necessary treatment and properly coded billing patterns against the corresponding covered loss; thus maximizing efficiency and savings to our customers.

MyMedlogix software employs the following automated analyst edits:

• Current and past state-specific medical fee schedules
• Applicable PPO fee schedules
• Applicable U&C calculation schedules
• Multiple procedure reductions
• Modifier calculations
• Trauma facility flags
• Policy limit flags
• Deductible and co-payments
• Interest calculation
• Crosswalks (correction of invalid code to a valid code, V-codes, ICD-9, NDC and CPT)
• NCCI edits
• Duplicate bill and line checking indicators

*Services are customizable by region and can be implemented on a combined or stand-alone basis

For bills where compensability, medical necessity or excessive charges are in question, Medlogix’s Medical Bill Auditing Services provide a sound solution.

Medlogix’s team of highly credentialed Nurse Auditors perform extensive reviews of Provider and Facility bills to ensure all billed services include appropriate supporting documentation and are causally-related to the claim.

Audit results are compiled and presented in a detailed narrative report to include an EOB worksheet which outlines eligible/ineligible charges. Medlogix’s Medical Bill Auditing Services are available for First and Third party Auto as well as Workers’ Compensation lines of business.

Program Features:

• Easy Referral via secure, user-friendly MyMedlogix web portal
• 24/7 access to information with built in alerts
• Audits performed by highly credentialed Nurse Auditors
• Detailed narrative Audit report/EOB
• Arb/Appeal Support
• ROI Reporting

To bolster our comprehensive Medical Bill Review solution, Medlogix offers CPT Code Review services to ensure provider billings are not unbundled, fragmented, up-coded, unrelated or improperly coded according to national and regional billing practices.

Medlogix’s expert team of Certified Coding Professionals review CPT-4 and ICD-9/ICD-10 diagnosis and treatment codes for outpatient services to assess and resolve inappropriate billing practices. Codes that are flagged for review can be customized based upon customer need and are triggered during the bill review process. Medlogix’s Code Review Services are available for First and Third Party Auto as well as Workers’ Compensation lines of business.

Program Features: 

• Expert team of certified coding professionals
• Full review of HCFA 1500 or UB92 and supporting medical documentation
• Detailed revision of EOB with line item explanation
• Provider contact (if necessary)
• Arb/Appeal Support
• ROI Reporting

Medlogix PPO solutions provide national access to in-network providers who are highly skilled in diagnosing and treating automobile and workplace injuries. This begins with our proprietary flagship CHN PPO, a leading preferred provider organization serving the northeastern United States with a premier, highly-credentialed network of over 140,000 provider locations. The CHN advantage includes in-house credentialing, customized network and panel development and on-going data integrity initiatives.

By partnering with select regional and national PPO networks that achieve high levels of credentialing, accessibility and cost savings consistent with our standards, Medlogix PPO delivers a seamless, coast-to-coast competitive edge to the customers we serve.

Program Features:

• National access to over 750,000 credentialed provider/facility locations
• Custom Network and Panel development
• State Certifications/compliance
• Contracts specifically cover Auto, Workers’ Compensation and Group Health
• 837 EDI, XML/Web services options
• Electronic EOB
• Streamlined Arb/Appeal Support
• ROI Reporting

Bill Negotiations reduce the costs of medical bills from providers and facilities not participating with a provider network for total cost management. The negotiation team proceeds with a review of UCR, Medicare, claims utilization history and in-network payment rates to aggressively negotiate with non-network hospitals, physicians, and ancillary health care providers to reduce costs.

Medlogix®’s Bill Negotiation program includes:

• Direct negotiations by experienced, highly-skilled negotiators with expertise and knowledge of rate levels
• Signed Letters of Agreement from providers
• Prospective and retrospective negotiations
• Customized referral criteria

When you need an independent, objective assessment to determine the medical necessity of treatment, Medlogix’s IME solution is the answer.  Our robust, multi-specialty offering of IME providers deliver objective assessments while demonstrating fairness and respect for the injured person. Our highly-credentialed network includes over 35,000 IME providers representing all relevant medical specialties. Medlogix’s IME Services are available for First and Third Party Auto as well as Workers’ Compensation lines of business.

Program features: 

• Easy Referral via secure, user-friendly MyMedlogix web portal
• Scan and store all documents on-line
• Schedule coordination
• 24/7 access to track all activity in real time
• Immediate notification if appointment is missed
• Nurse QA of Report
• Concise defendable reports
• Medical expert testimony available
• ROI Reporting

Medlogix’s comprehensive Peer Review network spans all provider types and delivers a like-specialty, retrospective review of provider billed treatment to determine whether care provided was medically necessary and causally related. Medlogix’s contracted credentialed providers are board certified in the same specialty as the requested medical review. Findings are documented in a detailed, comprehensive narrative report.  Medlogix’s Peer Review Services are available for First and Third Party Auto as well as Workers’ Compensation lines of business.

Program Features:

• Easy Referral via secure, user-friendly MyMedlogix web portal
• Scan and store all documents on-line
• Schedule coordination
• 24/7 access to track all activity in real time
• Nurse QA of Report
• Concise defendable reports
• Medical expert testimony available
• ROI Reporting

This prospective review of diagnostic tests, durable medical equipment, medical treatment and medical procedures supports auto carriers in maintaining NJ-AICRA compliance. Services may include prior authorization, utilization review and case management to determine whether the treatment plan is medically necessary and whether it provides for the appropriate level of care consistent with clinical protocols. Treatment that does not meet this criteria is escalated to a medical director. Medlogix® manages the entire pre-certification process, including appeals and dispute resolution.

For cases that require a physician review to determine medical necessity, Medlogix® provides access to highly-credentialed medical directors to provide professional guidance regarding the appropriate treatment of automobile injuries. Medlogix® maintains a fully credentialed staff of multi-specialty medical directors in all appropriate specialties, which includes numerous medical directors on-site at Medlogix®’s operations center. Medlogix®’s technology-enabled medical director review services deliver complete and defensible recommendations.

For complex or catastrophic cases, or treatment that is not progressing as expected, the direct oversight of a Field Case Management medical professional provides valuable guidance. Medlogix’s solution includes nationally certified Registered Nurses, CCM or CRRN, who assess and coordinate treatment by working with medical care providers, employers, attorneys, injured persons and their families to ensure appropriate, quality healthcare services are delivered in a cost-effective manner. The result is decreased hardship to the injured party and their family and reduced financial exposure for insurers. Medlogix’s FCM Services are available for Workers’ Compensation, Group Health and Auto lines of business.

Program Features: 

• Highly Experienced Nurse Field Case Managers
• Early identification and assessment
• Goal-oriented Case Management
• Discharge planning
• Comprehensive ROI Reporting

Requested for serious injuries and catastrophic claims, Lifetime Cost Projections provide a comprehensive evaluation of current and future treatment needs and expected medical costs associated with a claimant’s treatment plan. Medlogix’s Medical Management professionals perform an extensive file review including medical history, to deliver a detailed Cost Projection Analysis that adjusters use as a tool to establish proper file reserves. Medlogix’s Lifetime Cost Projection Services are available for Workers’ Compensation, Group Health and Auto lines of business.

Program Features: 

• Thorough Case assessment
• Medical records review
• Contact with injured party, care givers and product suppliers
• Evaluation of future treatment needs and costs
• Life Expectancy Projection
• Detailed report with electronic submission

Through the MyMedlogix portal, carriers have a single source for claim submission, provider look-up, customer service, claims tracking and provider nomination process.  Medlogix® delivers custom electronic data interchange (EDI) solutions to connect business partners’ applications with our proprietary Medlogix® software. Using our secure, automated process, business partners enjoy real-time processing of the most current PPO network data available. Our wide range of interface options include Web-services, XML and 837 formats.

Medlogix’s solution for handling Third Party Demand Packages provides knowledge and attention unmatched in the industry.

Medlogix provides an integrated solution through a combination of our proprietary MyMedlogix® medical claims management software and our medical and professional expertise.

Medlogix’s Third Party Professional Review services provides the tools to more effectively negotiate settlements with defensible supporting documentation.

Third Party Professional Review Services:

• Service options include the following:
• Medical Bill Review
• Medical Bill Audit
• Peer Review
• IME
• Litigation Support
• Professional Testimony

MyMedlogix Program features include:

• A secure web-based portal for on-line referrals
• The ability to scan and store all documents associated with the referral online
• 24/7 access to information to track activity in real time
• Two way, secure claim messaging system
• Electronic messaging alerts for important status updates
• Access to comprehensive on-line report packages