NANO MED (MRE)
NANO Medical Edits & Necessity Services
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NANO MED (MRE) Medical Rule Engine
Standardized by doctors of current clinical practices, specialty society guidance, and industry-certified coding.
NANO MED (MRE) helps providers comply with established medical coding standards. It applies clinical validation by a team of qualified nursing and coding specialists, reviewing claims for the billing errors that would otherwise be found by the payer.
The rules behind it come from a thorough review by physicians of current clinical practice, specialty society guidance and industry-standard coding.
It supports ICD-10-CM, ICD-10-PCS, CPT, HCPCS and ICD-9-CM code sets, and gives coders the detail they need to resolve edits during the coding process or to query a physician for clarification — which is what shortens coding delays and prevents medical-necessity denials.
Medical Claim Scrubber
A comprehensive medical claim scrubber and validation engine for medical claim forms. Helps in scrubbing and validation of medical claims. Avoids coding oversights and keeps one step ahead of denials before submitting claims to the payer. It directs to seek medical claims for faults and omissions that result in Payers’ denial or underpaid claims.
Claim Processing Management
Leverages automation features for hospitals and medical clinics to resolve or prevent any hurdles that can potentially disrupt the claims processing and billing workflow. Offers proper healthcare claims management with medical billing provision, revenue cycle management, and comprehensive medical practice management for payers, healthcare providers, and insurance providers.
Medical Necessity & Cross-Coding Edit Management
Offers medical code bundling, mutually exclusive coding, and duplications, maximum allowed frequencies, services relationship errors, and encounter related edits.
Payer Denials Management
Offers a compliance library for analyzing denial trends to uncover emerging trends by insurance carriers and redesigning or re-engineering the process to limit or lessen the risk of likely claim denials. Performs a thorough root-cause analysis and decides on the right solution for fixing the particular issue, helps to take corrective action, and submits the claim for payment.
Regulatory Compliance
Compliance with international medical classification with the world health organization. Medical codes meet the requirements of each regulator and cover over 36+ countries across the world. Ensures compliance with regulatory requirements based on the standard edits of (AR, CMS, ANA, ALIMA, etc.), ICD-CPT, ICD - HCPCS, ICD - CDT, ICD - DDC, ICD - ADDC.
Financial Analysis
Supports you in enhancing your financial performance through change management, business process improvement, and innovative technology—partners in preventing fraud and abuse within the system and ensuring that regulatory compliance requirements are met. Quick improvement in the provider billing revenue cycle to prevent fraud, waste & abuse.
Tariff -Contracting and Pricing
Ensures fair pricing of your provider contracts to maximize your revenue potential, cut costs and achieve a sustainable market positioning.
Clinical Content Information and Drug Monographs
Offers specialty-focused clinical information that easily transforms any HIT system into a comprehensive reference tool for healthcare professionals.
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Related products
Products in the suite that work alongside this one.
More about this product
Standards and code sets
- ICD-10-CM
- ICD-10-PCS
- CPT
- HCPCS
- ICD-9-CM
How this works with the rest of the suite
- NANO CSS
MED supplies the clinical rule content; the scrubber is the gate that applies checks to every outbound claim.
- NANO MCRW
The wizard influences the code being chosen, MED validates the clinical reasoning behind the claim as a whole.
- NANO MAS
Auditing reviews what was billed after the fact; the rule engine is how the same finding becomes a check that runs every time.
- NANO DRG
A medical-necessity denial and a grouping dispute are the same argument about whether the record supports the claim.
Frequently asked questions
What is a medical rule engine?
- Software that applies clinical and coding rules to a claim and reports what a payer would object to. The value is that the objection arrives while the claim can still be corrected, and with enough detail that a coder can act on it rather than simply being told it failed.
Where do the rules come from?
- From a thorough review by physicians of current clinical practice, specialty society guidance and industry-standard coding. That provenance is the point: a rule set assembled from payer behaviour alone would encode what payers currently reject rather than what is clinically correct.
Which code sets does it support?
- ICD-10-CM, ICD-10-PCS, CPT, HCPCS and ICD-9-CM. Keeping the retired set matters more than it looks — historical claims, audits and appeals continue to reference it long after new claims have stopped.
What does a coder actually see?
- Enough detail to resolve the edit during the coding process, or to raise a specific query with the physician for clarification. That is what shortens coding delays: an edit that says only that something is wrong becomes a second investigation.
How is this different from a claim scrubber?
- Overlapping but not identical. MED also includes a comprehensive claim scrubber and validation engine, but its distinguishing contribution is clinical validation by qualified nursing and coding specialists against physician-reviewed rules — which is aimed at medical-necessity denials rather than structural errors.