Health Net Plus Partners with Qmedtrix to Offer New WC Solution

Health Net Plus, the workers’ compensation managed care services unit of Health Net Employer Services Inc., announced that it has partnered with Qmedtrix Systems Inc. to offer a new electronic solution called Q-Worx to employer groups to help them manage workers’ compensation medical costs.

Q-Worx will assist employers in electronically reviewing bills for accuracy and fairness — ensuring in-network bills meet contract guidelines and out-of-network bills are within fair and reasonable charges.

“Through electronic solutions, such as Q-Worx, we can help our employer groups control excessive workers’ compensation medical costs,” said Tom Ash, president of Health Net Plus.

For Health Net Plus clients, Q-Worx software is installed and claims data transmits electronically through the Health Net Plus electronic interface application. Health Net Plus contracted provider and facility reductions are applied automatically to medical bills with results readily available to the customer.

“The Q-Worx solution provides clients an electronic connection to Health Net Plus’ nationwide physician and facility network, our pre-negotiated contract rates and Qmedtrix’s decision software — which helps to ensure that payments are accurate, fair, reasonable and within market rates,” added Ash. “The combination of these three key elements is designed to produce cost savings for our clients.”

In instances where a contract or a fee schedule does not exist, the Q-Worx “rules” engine is applied. The number of rules applied, or the modules utilized, can be customized for each client. All modules can be applied for maximum results which include: hospital outpatient facility charge review; ambulatory surgery center (ASC) facility charge review; surgery charge review; pain management charge review; inpatient DRG check; and self-referral screening.