What is the MEDLINK system?
It is a solution, which has the objective of connecting the providers of a medical network to the healthcare company, so they can make, in real time, eligibility and the authorization of claims and the capture of the data of the services for later payment.

What is eligibility?
Eligibility is the verification, based on the data of the claim to be done (user, provider, service, taxes, date), of the qualification of the user to have the requested medical assistance. This concept also applies to the provider, once it is necessary to check if it is part of the same medical network the user belongs to.

What is an authorization?
Authorization consists in approving or denying the execution of the medical service, based on the verification of the eligibility of the user and of the provider, which are detailed on the requested claim.

What is a capture?
The data that are used for the verification of the eligibility are the same used for the making of the billing of the requested medical service. Once the claim is authorized, the information related to the claim is already registered on the management system of the healthcare company for the execution of the billing routine of the provider.

What kind of healthcare companies can use the MEDLINK system?
All of them: insurance companies, group medicine companies, self-management companies, cooperatives or healthcare managers.

What kind of providers can be part of the MEDLINK system?
All of them: doctors offices, therapy and diagnosis services, specialists, clinics, dental clinics, hospitals and laboratories.

What kind of services/claims can be authorized and captured?
Every one of them: simple outpatient visits, visits associated to procedures, exams, therapies, and in patient procedures.

How does the MEDLINK system work in cases of internment?
Fundamentally, the MEDLINK system is oriented for out patient claims. The characteristics of this kind of event, whose start and end are foreseeable and immediate to the medical service, make possible the verification of eligibility, the authorization and the capture of the data in the same electronic transaction.

Is there, at this time, any MEDLINK solution in development?
Yes, there is. Medlink Technologies Inc. a wholly owned subsidiary of Transax - the company that owns and has responsibility for development of the MEDLINK system, works on the development of a solution of capture, in real time, of every data and items that relate to a hospital account, allowing the monitoring of the evolution of the bill for management and audit ends.

How is the connection undertaken?
The connection starts when the reading of the magnetic strip of the identification card of the user is undertaken. Then the provider must inform the data relating to the type of claim, so the electronic transaction can commence. There will be a verification , eligibility and the authorization or denial of the service. Once authorized, the provider may undertake the medical service authorized by the insurer.

Is it obligatory the use of the magnetic card?
No. But we believe that the use of the magnetic card provides more safeguards to the process and helps reduce fraudulent claims.

How do the providers connect to the healthcare company?
The MEDLINK system can be accessed through different solutions: MEDLINK Phone (by telephone, with IVR technology), MEDLINK POS (point of sale terminal, similar to the credit card terminals), MEDLINK PC (applicative software installed on the provider's computer), MEDLINK Server (installed in a server with the MEDLINK solution in the provider's location), MEDLINK PC NET (similar to the server solution but operating in a Windows environment) or through the MEDLINK web portal - the MEDLINK Web solution.

Why so many options?
We believe the advantages and benefits offered by the MEDLINK system increases when all the provider network is connected. This is possible because of the flexibility, of our solutions. The easy integration to the provider's environment is very important: the MEDLINK system does not impose adaptability patterns and does not demand major modifications to the provider's structure.

How is it possible to know the best form of connectivity for one provider?
The implementation of a MEDLINK solution is preceded by a number of steps that clears this question. One of them consists to analyze the environment of each provider, its volume of transactions and the nature of the services, so we can identify the kind of connection and MEDLINK solution that best fits the provider's environment.

In case that there are many providers sharing the same clinic or environment, is there the necessity to install f many terminals?
No, because all the MEDLINK connectivity resources allow sharing - many providers can use the same terminal (POS and PC), even if they belong to different healthcare plans (since the healthcare plans are part of the MEDLINK network). But if the volume of transactions justifies the installation of more than one terminal, this is completely possible.

How does the MEDLINK system deal with controlled procedures, when the user has to obtain guides or previous authorizations?
Controlled procedures - with rules that have to be observed as pre-conditions for the release of the service - are automated by the MEDLINK system, dispensing the necessity of phone calls to a call center or the dislocation of the user to an attending center.

Is it MEDLINK that analyses and authorizes the execution of a medical service?
No, it is the healthcare plan, through its authorizer.

What is an authorizer?
It is an application that has parameters for every business rules set for the verification of the eligibility and authorization of the medical procedures. Those rules include all the data of the users, their kind of plans, medical providers and their contracts, history of utilization of the user and the many tables used by the healthcare company to analyze the events.

Does the authorizer have direct access to the database?
Not necessarily. If the healthcare company chooses to preserve its database, the authorizer can contain many tables with the important data, to be imported and kept just in time.

And if the healthcare company does not have or is not interested in develop an authorizer?
Medlink Technologies Inc. can provide or build a specific authorizer with the software being housed at the insurer or on the Medlink Network processor.

Where is the authorizer installed?
The healthcare company decides where to place the authorizer. It can be placed close to the Medlink network manager or in the physical location of the healthcare company.

Who is responsible for the authorizer?
The authority and responsibility for every rule and data used by the authorizer are entirely the responsibility of the healthcare company.