MEDLYTIX, LLC

VET · Veterans

Department of Veterans Affairs healthcare payment integrity, claims accuracy, and improper-payment reduction, including third-party insurance recovery and insurance discovery for non-service-connected care under 38 U.S.C. 1729, and Veterans Community Care Program payment integrity (duplicate-payment detection, authorization controls, and billing accuracy). Application of predictive analytics and payment-integrity tools within the Veterans Health Administration, including at the Veterans Integrated Service Network (VISN) level, and VA revenue-cycle modernization.

GOV · Government Issues

Government-wide fraud, waste, abuse, and improper-payment reduction, including pre-payment controls and high-risk fraud detection across federal benefit programs, and cross-agency healthcare payment integrity and data coordination between the Department of Veterans Affairs and the Centers for Medicare & Medicaid Services to identify duplicate federal payments and overlapping coverage.

MMM · Medicare/Medicaid

Medicare beneficiary eligibility verification and data access for healthcare payment-integrity and coordination-of-benefits purposes, including access to the CMS HIPAA Eligibility Transaction System (HETS) and Medicare Beneficiary Identifier (MBI) look-up for authorized trading partners; CMS HETS Trading Partner Agreement policy and approval process; and use of Medicare eligibility data to identify overlapping coverage and duplicate federal payments across Medicare and the Department of Veterans Affairs.