Electronic Medical Records [EMR]
MedinClaim relies on a centralized database to store data on claimants, claims, providers, codes, rules, and every other elements needed for rigorous claim adjudication. At the heart of the data repository is a centralized EMR where MedinClaim captures data from CCDs.
The EMR accumulates historical information about the insured, making it possible to cross-check claim data across different claims, plans, and types of insurance, to ensure accurate processing and fraud detection, and to eliminate overpayment. The automated MedinClaim algorithms run centrally on the EMR records to check automatically:
(a) the match between the CPT code and the diagnosis that appears in the bill and the procedure that has been performed (if at all) that appears in the medical record;
(b) the reasonableness of the treatment that has been billed with respect to the medical history that appears in the EMR (including previous treatments)
(c) the causal relation between the insured event and the treatment that has been billed
The EMR provides the insurer greater visibility and service improvement through faster response time and results that are not biased by human adjusters.