Pre-Pay Medical Compliance Review

The Medliminal advantage is achieved by combining top machine learning processes with our expert team to make sure every claim receives a thorough line-by-line review. Our Compliance Review Process begins with our proprietary Robotic Process Automation (RPA) known as H-CAT™ before being reviewed by our experienced nurses and certified coders.

Medliminal’s medical professionals examine billing errors that are well beyond the scope of a traditional audit. With less than 1% turnover rate on appeals, we’re confident that our findings are rock solid.

How the Pre-Pay Compliance Review Works For Your Company

Step 1

Hospital visit produces UB-04 and itemized bill

Step 2

UB-04 and itemized bill uploaded to secure FTP site

Step 3

UB-04

Itemized Statement

Compliance Review Performed

Step 4

Option One

Explanation of Review (EOR)

TPA Reimburses Based on Mediminal Report

Discount Applied

Planned Benefit Coverage Applied

Payment Processed

Option Two

Explanation of Review (EOR) – Includes Discount and Benefit Limits

Mediminal Settles Bill

Bill Goes to Medliminal Resolution Team

Signed Settlement Letter

To TPA for Processing

Our services

Focused services that deliver innovative solutions that reduce healthcare costs for all payers.

Pre-Pay Medical Compliance Review

Through orchestration of our proprietary RPA system, H-CAT™ and our experienced nurses and certified coders, Medliminal provides a line-by-line medical bill compliance review.

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POST-Pay Medical Compliance Review

Unlike other cost containment companies, Medliminal not only identifies medical bill overcharges, but recoups those amounts up to a 2 year look back.

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DICEROS, Medliminal’s Affiliate Law Firm

By working alongside our affiliate law firm, Diceros, we assist in the recovery of overcharges identified through our compliance review process. Together, we work diligently to secure our clients’ plan assets by grounding our findings in robust, fair legal strategy.

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Who We Serve

Employees

Consumer driven health plans are failing employers and employees alike. It is necessary for the employee to be an educated consumer. Medliminal provides educational support and advocacy with respect to the medical costs facing individuals and their families.

Employers

Employers have a fiduciary responsibility to ensure the accuracy of charges on employee’s medical bills. Medliminal acts as your fiduciary compliance partner by assuring compliance with ERISA.

Insurance Companies

The Medliminal solution also helps the insurer, offering cost savings by identifying billing errors through our line-by-line medical bill review.

Taft-Hartley Funds

Medliminal’s medical bill compliance review helps your board of trustees fulfill its fiduciary duties by identifying billing errors, safeguarding the integrity of your joint finances.

Regional Health Plans

While your team handles medical necessity, Medliminal focuses on examining and removing billing errors from medical bills. The Medliminal solution identifies and removes billing errors pursuant to CMS guidelines, the regional health plan’s payment policie

Third-Party Administrators

Our compliance review targets non-billable services, supplies and equipment that are already factored into the cost of other charges and/or the cost of doing business. Medliminal does not conduct audits, we specialize in medical bill compliance review.