Qmedworx reviews workers’ compensation medical bills, and group health and auto medical claims, and makes recommendations for fair and reasonable reimbursement. After a claim is reviewed, Qmedworx’s professional negotiators contact providers and facilities to negotiate on behalf of our payers.

Based on each client’s customized program and bill criteria, Qmedworx’s services apply to all bill types.

Our unique methodologies allow us to identify fair and reasonable reimbursement for medical procedures. Our negotiation process takes a three-pronged approach:

	Strong understanding of medical procedures and the costs associated with them
	Expertise in the legal defense of our methodology
	Robust proprietary database built upon paid data

Our non-network negotiation program is available to all payers and is fully integrated into our nationwide, total cost-containment solution. We use our comprehensive proprietary database to understand provider billing patterns based on geographic region.

While many negotiation services are based on top-line charges, Qmedworx takes a unique approach. Our experienced staff negotiates claims based on recommended “baseline” costs that represent fair and reasonable reimbursement for medical procedures. Resulting from a careful, detailed review of every claim, our recommendations provide a solid foundation to begin negotiations.

As part of the process, Qmedworx secures a signed provider agreement acknowledging acceptance of the recommended payment to assure no balance billing to the member, patient, injured worker or payer.