The New Generation of Claims Management
New and innovative treatment options are constantly being introduced into the medical field as a result of rigorous medical research and rapid technological advance.
The abundance of options complicates achieving quality medical care due to the difficulty of sifting through the slew of available treatments.
This often results in the prescription of unnecessary treatments and procedures either due to a lack of available information or as a result of financial considerations.
Claims Management: Not Just Eligibility
Within this medical environment, policy caps and exclusions are not sufficient to meet these challenges. Generic eligibility definitions are either over inclusive; leading to uncontrolled spending, or under inclusive; damaging the patient’s treatment and loweringcustomer satisfaction.
Applying quality medical standards and an individual review to the claims process serves as an effective middle ground between these two polarities. Medical review excludes treatments that are deemed ineffective or irrelevant, while including suitable options. In this way excessive spending is avoided while ensuring a high level of medical care and customer satisfaction.
Comprehensive
Medical Claims Management
Medical Eligibility
Medical Eligibility Review entails applying medical policy definitions such as chronic, cosmetic or experimental to the requested treatments. These definitions are constantly changing and often unclear. Applying them to a specific claim requires medical expertise and a deep understanding of the patient’s condition. Preforming this check is an essential part of the MediGov claims review.
Medical Validity
Medical Validity Review ensures that the proposed treatment is in fact recognised as a valid option for the patient’s diagnosis and condition. Our physicians assess each claim, calling on experience, expertise and internationally recognised treatment guidelines to reach sound medical decisions.
Medical Necessity
Medical Necessity Review includes assessing whether or not a valid treatment is necessary given the patient’s specific medical condition.. As with validity, international guidelines are applied as well as specialist expertise and experience.
Length of Stay Management
Our necessity and validity review applies to specific treatments and inpatient stay alike. Through this method, we are able to strike an optimal balance, keeping the patient admitted while required, and discharging immediately thereafter in order to prevent further costs and potential complications.
Excessive spending is avoided while ensuring a high level of medical care and customer satisfaction
Why MediGov?
MediGov was established with the purpose of providing a comprehensive set of claims management services. Services are provided by a staff comprised of physicians, nurses, para-medical personal, therapists and customer service representatives.
Our diverse range of expertise provides us with the insights and tools necessary for successful activity in healthcare service provision globally.
Contact Us
118 Piccadilly, London W1J 7NW, UK | T +44(0)20 7036 1230 | F +44(0)20 7569 6800 | claims@medi-gov.com
