Platform

Healthcare Decision Systems.

A unified suite of AI-based platforms that bring decision intelligence to every stakeholder in healthcare — purchasers, plan sponsors, members, and providers. Six interoperable systems, one source of truth.

IMDS™

Individual Medical Decision Systems.

The core of MedExpert. IMDS™ delivers evidence-based, beneficiary-focused medical guidance to individual members at every meaningful decision point — diagnosis, treatment, second opinions, post-acute care.

Member-level

Each interaction is grounded in the member's specific clinical picture, claims history, and benefit design.

Evidence-based

Recommendations draw from 22,000+ EBM-covered conditions and 16,000+ pharmaceuticals, kept current with medical innovation.

Zero exclusions

No condition is out of scope. The system serves every beneficiary, including comorbidities and rare conditions.

ReconHealth™

Integrity System.

The integrity layer that catches waste, fraud, and abuse before claims are paid — not after. ReconHealth™ reconciles clinical, claims, and benefit data to surface anomalies and inappropriate utilization in real time.

Pre-payment review

Catch problems upstream of disbursement, where dollars are recoverable.

Cross-source reconciliation

Eligibility, claims, encounter, and clinical data are matched and validated continuously.

Auditable trails

Every flag is documented and defensible — built for plan sponsor and regulator scrutiny.

QMMS™

Quality Medical Management System.

QMMS™ is the operational engine for population-level quality improvement. It coordinates the work of clinicians, advocates, and analysts on a single platform, automating the parts that don't need human judgment so people can focus on the parts that do.

Workflow automation

Routine clinical and administrative steps are handled automatically — without losing the audit trail.

Care coordination

Case managers, nurses, and advocates work in shared context, not parallel silos.

Outcomes measurement

Closed-loop tracking from intervention to clinical and financial outcome.

Advanced EOB

Explanation of benefits, reimagined.

MedExpert's patent-pending Advanced EOB delivers the cost-and-coverage transparency the No Surprises Act and CAA require — in a member-friendly format that drives understanding, not confusion.

Pre-service estimates

Members see a clear, accurate view of expected costs before care is delivered.

CAA-aligned

Built to satisfy the CAA's Advanced EOB requirements without bolt-ons.

Plan-design aware

Estimates reflect deductible, accumulators, network, and benefit nuance — not just charge masters.

Price Transparency

Cost visibility across the system.

Machine-readable files, member-facing shopping tools, and the analytical infrastructure to make price-transparency data actually useful — for purchasers steering plan design and members making care decisions.

MRF generation & hosting

Compliant machine-readable files for in-network rates and out-of-network allowed amounts.

Member-facing tools

Searchable, plan-aware cost comparison surfaces.

Purchaser analytics

Surface where you're paying above market, by service line and provider.

MIInformed

Member-facing decision support.

The member-facing layer of the platform. MIInformed brings evidence-based guidance, plan navigation, and advocacy directly to members — by phone, app, and web.

Always available

Members reach a real advocate, not a deflection tree.

Evidence-grounded

Every conversation is informed by current clinical evidence and the member's plan design.

Conflict-free

No financial ties to providers, drug companies, or hospitals. Advice serves the member, not a vendor.

See the platform in action.

We'll walk you through a live demo tailored to your population — Medicaid, Medicare, Taft-Hartley, commercial, military, or rural. 30 minutes, no obligation.

Book a demo