NANO MED (MRE)

NANO Medical Edits & Necessity Services

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.