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Solutions
Description
Compatibility Level
Clients
Use cases
EHR integrations
Client types
Awards
Differentiators
Keywords
Media
Company details
Jump to:
Categories
Solutions
Description
Compatibility Level
Clients
Use cases
EHR integrations
Client types
Awards
Differentiators
Keywords
Media
Company details

Categories

Solutions

Description

Product Description:
MedData’s Denials Management Outsourcing Services improves your business office’s effectiveness by allowing it to concentrate on areas of the revenue-generating process that have a higher yield and do not distract hospital account representatives from their primary duties. We have dedicated specialists who focus on denials management nationwide with extensive experience working with ALL payer types, scenarios and denial reasons. MedData provides invaluable feedback to help the hospital improve its approach to the denial management process. We provide reports on a monthly basis (or as needed) that track payer, denial type, service, and physician’s issues. This helps our clients improve their internal processes that in turn will lead to long-lasting gains in Accounts Receivable performance. MedData works all denial types including: • Lack of Authorization • Insufficient Authorization • Medical Necessity • Unresponsive Recoupments • Coverage Exclusions • Pre-existing Condition • Coordination of Benefits • Timely Filing • Subrogation\Accident Details • All Denial types (administrative/clinical) MedData also has a dedicated focus on unresponsive patient denials (UPDs), which consist of any denial type where the patient’s and/or subscriber’s involvement is required in order to secure resolution on the claim. Our service helps prevent these denials from getting lost in self-pay and ending up in bad debt. UPDs include, but are not limited to: • Coordination of Benefits (COB) • Pre-existing questionnaires • Incident letters • Accident letters • Adding newborns to policies • Subrogation forms • Authorizations • Any other time a patient’s involvement is required by the insurer The benefits of utilizing MedData to perform your denials management is that we have the following performance drivers: • Dedicated RNs on staff for medical necessity reviews, peer to peer coordination, etc. • Primary focus on Commercial and Medicare/Medicaid claims • Strategic focus and prioritization based on dollar balance and/or potential reimbursement, age, and timely filing requirements • OCR capabilities for digitalization of hard copy remits/EOBs • Dedicated compliance team and internal legal resource with nationwide legal partnerships • We aggressively work the account until it is 100% resolved • Complete “feedback loop” to prevent future denials through a rigorous root cause analysis process • Close coordination with contracting department to ensure compliance and provide insight for future contracting • Overturn denials through the appeal processes when necessary • Incoming and outgoing call campaign with the patient • Patient texting capability • Streamlined patient letter series • Skip trace with three levels of escalation
About MedData:

MedData has been a tenured and trusted healthcare revenue cycle management services provider for more than 40 years, delivering technology-enabled and patient-focused RCM solutions, including Eligibility & Disability, Accounts Receivable Services (ARS), Injury Accounts (Workers’ Comp, Auto, etc.), Veterans Administration, Patient Responsibility/Early Out, COB Denials, and Out-of-State Eligibility. MedData has patient advocates from coast to coast and experience with hospitals and health systems of all types – large to small, rural to urban, nonprofit to for-profit – giving the company a nationwide presence with a local feel that’s scalable to any volume. Click the "Files" tab for downloadable content with more information about our organization.

Product Description:

There is a different way to work. If you were to reimagine the way you run your business, what would you do differently? What if you could save up to 80% of your operational costs by reimagining the way business outcomes are delivered?

Through the power of automation emerging technologies, we challenge you to think differently about how you work and how you use your people to full effective.

We can help you across the automation journey from thinking through your strategy to implementing and executing robotic process automation, machine learning and other emerging technologies across the enterprise.  

Revenue Cycle Management:

Prior Authorization ​

Insurance Claims - Posting

Patient Payment - Posting

Coordination of Benefits: Primary, Secondary, & Tertiary

Revenue Integrity - Payment Audits (Under & Over)

Provider: Insurance Enrollment

Revenue Integrity - Charge Description Master (CDM) Management

Revenue Integrity - IME or IMR Audits (CMS & Medicare Advantage)

Insurance Claims - Denied & Rejected Follow-Up

About TQA Healthcare - Formerly Element Blue:

TQA Healthcare enables healthcare and life sciences organizations to transform the patient experience and reduce costs through increased personalization, intelligent automation, and AI. 

The practice’s solutions impact patient access, the revenue cycle, order processing, and clinical needs at the most critical stages of the patient journey, resulting in a seamless encounter.

By empowering individuals to actively manage their unique experiences, TQA Healthcare increases the satisfaction of every healthcare consumer: patients, staff, and clinicians.

Houston-based, TQA Healthcare is formerly Element Blue. 

Compatibility level

Select which hospital or health system you work at and see a personalized compatibility level.

Clients

Select which hospital or health system you work at and see the client list

Use Cases

Description:

None provided

Pediatric use cases:

None provided

Users:

None provided

Description:
  • Prior Authorization
  • Claims Status
  • Coding
  • Scheduling
  • HIM
  • Remittance Posting
  • Provider Credentialling
  • Accounts Payable
  • Human Resources
  • Clinical Services
  • Patient Access
  • Revenue Cysle Management 
  • Supply Chain
  • Finance
  • HR
  • Referrals
  • Faxes
  • PDFs
  • Emails
  • Scans
  • Invoices
  • Patient Charts
  • Patient Records
  • Lab Orders
  • Mail
  • Paper Documents
  • Resumes
Pediatric use cases:

Same as for any health system, but additional applications related to newborn insurance and patient proxy for infants and children.

Users:

Revenue Cycle Leaders

Finance Leaders

IT Leaders

HR Leaders

HIM Leaders

Operations Leaders

EHR Integrations

Integrations:

None provided

EMR Integration & Relevant Hardware:

None provided

EMRs Supported:

None provided

Hardware Compatibility:

None provided

Integrations:

Acute care EMR, Ambulatory EMR, Ancillary EMR, ERP system, Patient portal, Pop health platform, Home health, Behavioral health, Community based organizations, ADT, Access +/or revenue cycle, Credentialing, Website / public online sources, Other

EMR Integration & Relevant Hardware:

Not applicable

EMRs Supported:

Epic, Cerner, Meditech, Allscripts, NextGen, athena, GE, eClinicalWorks, McKesson, Other, Allscripts/Eclipsys, Athenahealth, Azalea Health/Prognosis, CPSI, Evident, Healthland, MEDHOST, MedWorx, QuadraMed, Self-developed, Would prefer not to disclose, Point Click Care

Hardware Compatibility:

Not applicable

Client Types

Awards

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Differentiators

Differentiators vs EHR Functionality:

None provided

Differentiators vs Competitors:

None provided

Differentiators vs EHR Functionality:

While EHRs offers integration tools, achieving seamless data exchange, particularly with non-EHR systems, can be challenging due to their limited interoperability.

This can create communication hurdles between providers using different EHRs, healthcare facilities not on a particular EHR, and providers who need to integrate with other advanced technology platforms outside of the EHR ecosystem.

Element Blue's solutions can integrate with any platform and are independent of particular products or technologies. This affords our teams unlimited creativity when ideating custom solutions for each healthcare organization.

Differentiators vs Competitors:

Element Blue's practice is dedicated exclusively to healthcare and life sciences. This is unique among our UiPath competitors, who serve multiple industry verticals.

A UiPath Platinum partner, Element Blue is recognized as a leading systems integrator with more than 20 years' experience in working with some of the world's best known providers, payers, diagnostics, and life sciences organizations.

Keywords

Images

No images provided

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Videos

No videos provided

1 of 3

Epic Claim Denial Resubmission with BCBS.mp4

Downloads

No content provided

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66329_EB RPA Case Study REVISED.pdf

Alternatives

Company Details

Founded in 1980

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