Medata’s Adjustor Toolbox application is a web-based, workflow management system designed to allow users to access bills and perform a variety of functions, including approving a bill for payment or sending a bill out for external review. Additionally, since Adjustor Toolbox utilizes a relational database to store all bill review information, it serves as a powerful reporting tool. Adjustor Toolbox was designed for the claim representative to adjudicate, route, and easily work provider bills from any location. Through Adjustor Toolbox, the client can establish, automate and manage its preferred bill review workflow, based upon user-defined business rules. This robust workflow engine enables the client to determine its own level of aggressiveness in managing medical costs. Every step of the medical bill adjudication and payment process can be automated and monitored.

Adjustor Toolbox also facilitates physician and hospital bill reviews during the retrospective review process. The client would also have the ability to request peer reviews, either manually or in an automated fashion, based upon defined utilization criteria. The peer review personnel will receive the billing history, specific Medata utilization reports, and, if the client uses the imaging functionality, the medical records. Upon completion of the review, the peer review recommendations will be loaded into the Adjustor Toolbox for the client's review. Rules can also be set to impact payment decisions for future bills, based on the peer review.

In addition, Adjustor Toolbox is especially helpful in researching claim history and monitoring potentially fraudulent practices. Adjustor Toolbox builds on the strengths of our Procedure Analysis Report (PAR) and Advisor functions by incorporating both into the system. Together, these functions allow the user to compare a particular bill with bills previously submitted by all providers. This security-compliant application also provides real time, on-line management reporting to ensure jurisdiction-related on-time processing.