Magik Consulting is a Powerhouse in the Design & Development of Benfits Administration, Claim Processing Products and Custom Solutions for HealthCare Payer Organizations in the US.

IT Services

  • Cloud Computing Services.
  • EDI (Electronic Data Interchange) Services (Standardized Format to send Business Information to Other Compaines Electronically) on all X12 (Standard Protocol) Transactions 837P, 837I, 835, 834, 278, 270/271, 276/277 (Professional Formats Utilized by All Healthcare Professionals.
  • Developing Custom Utility Programs for Healthacre Digitalization.
  • EHR – Electronic Health Records.
  • Medical Databases.
  • Medical Research.
  • Medical Diagnosis.
  • Medical Imaging.
  • E- Prescribing Software for Rx.
  • Telemedicine.
  • Appointment Scheduling / Booking.
  • Medical Billing.
  • Hospitals/ Clinics/ Labs/ Imaging Centers & Facility Management.
  • Medical Equipment Management.
  • Helath Tracking Apps.
  • Personal Helath Records (Medical Diaries).
  • RPM- Remote Patient Monitoring.
  • Mobile Health Apps.
  • Devleoping Reports from Simple to Complex for Compliance, ODAG (Organization Determination for Appeals & Grievances), CMS.gov (Centers for Medicare & Medicaid Services).
  • Support for Quality of Care : HEDIS (Healthcare Effectiveness Data & Information Set) & NCQA (National Committe for Quality Assurance), Certifictaions (30-35 Pre-Defined Quality Measures).
  • Developing Power BI Dashboards and Analytical Reports using Power BI.
  • Interoperability Files (X12 EDI/ HL7/ FHIR Fast Healthcare Interperability Resources) Data Standard etc… Capturing and Exchanging Data between different Computer Systems regardless of how it is stored in those Systems.
  • Creating Applications for Medicare, Medicare Advantage and Medicaid Clients.
  • Creating Customized Applications in Care Management / Assisted Living & Senior Citizen Facilities.
  • Document Management Systems.
  • Provider Credentialing (Capturing and Verifying Provider Information).
  • On-Site Project & Program Management with Highly Skilled Technology Resources.
  • Creating Fee Schedules – Rate Card from CMS(Center for Medicare & Medicaid Services)/ Health Plans from all Healthcare Co’s.
  • Creating Benefits from EOC (Evidence of Coverage) file.
  • Setting up Auto Adjudication Rules for Auto Certification.
  • Devloping Custom Webistes (Static & Dynamic).
  • Develpoing Customized EMR’s Custom Management, Patient Scheduling & Patinet Case History Database Application for:
    • Hospitals.
    • Clinics & Doctor’s Offices.
    • Imaging Centers.
    • Labs.

  • Support in Medicare, Medicaid Benefits Administraction.
  • Eligibility / Refferals & Prior Authorizations /Claims Processing / Payment Processing.
  • Migrating Data from Legacy Systems to Newer Systems.
  • Archiving Data for Future Referencing Purposes.

IT ENABLED SERVICES – PROCESS MANAGEMENT

Claims Triage: Triaging of Claims pertaining to CMS, UB, White Bills, Self-paid and other Claim related documents like Proof of Travel, Proof of Payment, Medical Records etc., received thru the
Clearing House, Fax, Emails, Online Portals. Search for policies/claims in CCI tool and attaching documents to respective Claims.

Claims Data Capture: Entry of Healthcare Claims i.e., CMS, UB04, Provider Claims (White Bills) and Self Paid Bills (across the World Claims), we also enter and verify claims in OCR tool. We work
monthly volumes of 20,000 plus claims with a Turn around time of 24 hours from the time Claims are routed for entry.

Claims Assessment:
Full Assistance Claims :These are policy-based products. The assessors will have direction from the assistance teams to determine whether claims are payable or not in conjunction with the policy terms. Threshold <$5K paid from India. >5K – Paid from Canada.
Cost Containment: These claims do not have a policy. These claims are processed solely at the direction of a TPA (Third Party Administrator) or Underwriter. Threshold <$5K.

BUSINESS PROCESS MANAGEMENT SOLUTIONS

Provider Outbound Calling: Provider outbound calling is performed to obtain missing information,
requesting original bills, apart from working on inpatient claims to check the balance as on date. We work around 1500 workflows per month until the objective of the workflow is met.

Admin Tasks: Handle various admin tasks like kicking out cases from automation process, updating
EDI claims & uploading documents to various corporate clients. Identifying NPI’s for providers and
also identifying claims stuck in automation and clearing them out.

CareIntelli – Signature Healthcare Management Application

CareIntelli stands at the core of our healthacre innovation — a versatile, scalable and fully customizable Healthcare Management Application. Purpose – built for care managers, case coordinators and healthcare providers, it delivers:

  • Proactive risk identification.
  • Seamless care coordination.
  • Multilingual member engagement.
  • Compliance with FHIR, HL7, OWASP, and WCAG standards.
  • CareIntelli empowers healthcare organizations to deliver efficient, connected, and compliant care across diverse ecosystems.