Qmedtrix

Company: Qmedtrix
Company Description: Inappropriate billing is widespread in health care, but Qmedtrix’s decision software and systems make it possible to determine a fair and reasonable charge for every medical service. Qmedtrix reviews medical bills for accuracy and medical appropriateness, identifies fair, reasonable and defensible reimbursement for every service, and promotes the highest quality care.
Nomination Category: Team Awards Categories
Nomination Sub Category: Best Product Development Team

Nomination Title: Qmedtrix, Product Development, Systems Development and Quality Assurance Team

Tell the story about what this nominated team achieved in 2003 (up to 500 words). Focus on specific accomplishments, and relate these accomplishments to past performance or industry norms. Be sure to mention obstacles overcome, innovations or discoveries made, and outcomes:

Qmedtrix’s decision software and systems, based on a proprietary database and
rules engine, provide medical bill payors recommendations to accurately
determine fair payment. Qmedtrix’s quest: To reform health care. How? Through
bill review services and systems that recommend fair reimbursement to providers,
encourage higher quality health care for patients, and help halt runaway charge
inflation. 

Historically, medical bill payors have paid whatever was charged—regardless of
the accuracy of the charge or the appropriateness of the medical procedure—and
raised premiums, billed patients or used more tax dollars to compensate.
Traditional cost-containment services take a standard discount, encouraging price
inflation.

Qmedtrix provides a unique alternative that is changing the face of health care. In
2003, Qmedtrix identified $270 million in overcharges, and provided defensible
reimbursement recommendations to payors. The accuracy of its methodology
enables Qmedtrix to offer payors expert witness testimony for any disputed bill. 

Because health care charge inflation translates into higher insurance premiums
and costs—which in turn means state budget deficits, failing businesses and lost
jobs—Qmedtrix’s efforts benefit millions of Americans.

Qmedtrix’s dynamic development team—including product development, system
development and quality assurance experts—continuously researches, codes and
tests to continuously improve the unique rules engine and proprietary database
that support our services and systems. Determining the appropriate charges for
every medical service in every geographic area requires a unique knowledge base.
The team must capture, analyze, maintain and use nationwide current and
historical data for both paid and charged amounts. Then, it customizes interfaces
for each customer’s unique communications and data exchange methods.

This year, the team took an established service, BillChek, and expanded both the
services it offers and its scope. BillChek is now a total out-of-network nationwide
solution offering bill review services for every bill type in every line of health
care.

In 2003, the team developed Q-worx, and provides ongoing technical and
operational support. Q-worx adjudicates bills in all 50 states—combining our bill
review services with PPO network contracts and complete EDI capabilities.

Qmedtrix’s team also supported the development of a new wholly owned
subsidiary, Qmedworx. In the past, Qmedtrix’s focus was on workers’
compensation bill review, because bill balances cannot be charged back to the
patient. This left auto medical and group health—where the bulk of the nation’s
$1.6 trillion annual health care expenditure lies—unprotected. 

Qmedworx negotiates charges for all types of bills in all lines of coverage
nationwide. First, it uses Qmedtrix’s rules engine and database to identify
inaccurate charges and abuses. Then, Qmedworx begins negotiations from
a “baseline” of what charges should be, rather than negotiating down from the
originally inflated bill. Once a settlement is reached, a secured agreement is
signed by the provider accepting the negotiated amount. This prevents any
balance billing, while providing substantial savings to patients and payors.

Qmedtrix team is committed to developing cost-containment solutions that provide
fair compensation to providers, quality care for patients and an end to the health
care crisis in America.

List hyperlinks to any online news stories, press releases, or other documents that support the claims made in the section above. IMPORTANT: List each link on a separate line, begin each link with http://, and enclose each link in square brackets; for example, [http://www.website.com]:

Intracorp Employs Qmedtrix Solutions:
http://www.qmedtrix.com/news/PR/pr_015.html
Growth Company of the Year:
http://www.qmedtrix.com/news/PR/pr_012.html
OEF Growth Company Award:
http://www.qmedtrix.com/news/Articles/Qmedtrix_OEFArticle.pdf
Technology Fast 50:
http://www.qmedtrix.com/news/PR/pr_011.html
Top 50 Technology Company:
http://www.qmedtrix.com/news/PR/pr_006.html
Top 100 Private Company:
http://www.qmedtrix.com/news/PR/pr_004.html
Top 100 article:
http://www.qmedtrix.com/news/articles/Qmedtrix_BJ_Top100.pdf
Appointments:
http://www.qmedtrix.com/news/PR/pr_010.html

Provide a brief (up to 100 words) biography about the leader(s) of this nominated team: