Cost Containment

Outsource Bill Review

Software Lease

Medata offers a flexible Software-as-a-Service (SaaS) application operated in a dedicated private cloud environment in best-in-class SSAE16 SOC Type I and II data centers. Our robust software allows for workflow configurations and business rules developed per the individual needs of each client. This fully customized software offers multiple layers of review and functionality, including proprietary cost analysis features and a reasonableness database. We offer in-depth, hands-on training and technical support is available 24/7.

Specialty Review

Prospective and retrospective savings are achieved on out-of-network bills, services where fee schedule guidelines do not apply and/or any client-designated bills. The MSR team works directly with the provider to secure a mutually-agreed upon rate. Our negotiators are experts in jurisdictional fee schedules, health care payment policies and prevailing billing practices. The team’s resources include our Medical Advisory Panel which is comprised of physicians from multiple specialties.

MSR is integrated into your bill review workflow or is available as a stand-alone product.

Utilization Review

An end-to-end process that starts with the utilization review request and continues seamlessly through to the final decision reflected on the EOR sent to the medical provider. With this industry-first integration between Bill Review and UR, the user can be confident that submission for payment for non-certified treatment will be stopped and those treatments that have been authorized can be adjudicated without any additional manual intervention by the adjuster or bill review analyst.

Medata leases its utilization review software for in-house programs, or offers a complete outsource service operation.

Do your needs fall outside a standard service model?