MCO delivers a fully functional claims payment system for the business management of Payor organizations
Improve the speed and efficiency of claims processing, resulting in enormous time and cost savings.
MCO enables health plan payors, third-party administrators and self-administered employer groups to manage their operations in a more efficient, real-time manner with a lower cost basis. MCO coordinates all of the touch-points in a health plan enterprise, including: benefit administration; provider networks; member enrollment; medical management; claims processing; business rules; workflow; customer service (member and provider) and daily operations.
MCO Product and Service Components
MCO is a fully-integrated, feature-rich, Windows-based application that is fully HIPAA compliant and delivers the core functionality required to meet the complex processing needs of payors.
MCO is comprised of the following components:
- Membership — provides a unique split between benefits and member liabilities (co-payments, coinsurance, etc.) to greatly reduce benefit administration
- Providers — re-usable fee schedules, carve-outs, payment rules, stop-loss, multiple surgeries, contiguous body areas and a host of reimbursement methods
- Claims — entry of professional, institutional dental and pharmacy claims
- Request/Call Tracking — track calls from providers and members, as well as track internal workflow
MCO is a comprehensive and integrated solution that helps you to improve your income potential with:
- Customizable rules-based auto adjudication for enterprise-wide workflow automation
- Improved medical management review and utilization
- Provide member/provider inquiry information via the Internet
- Claim payments are automatically assigned to your own customizable G/L Codes
- Claim encounters can be valued against community-based fee schedules for tracking external or in-house expenses
- Integration of Enrollment, Eligibility, Member, Provider and Group Management, Utilization Review, Customer Service, Claims Adjudication, Financial Management and Reporting
MCO’s flexible relational database architecture also allows you to identify additional income opportunities, as well as pinpoint and eliminate troublesome bottlenecks long before they appear on your bottom line.
Flexible and scalable for growing organizations
MCO, like all RelayHealth solutions, is easy to use. MCO uses object-oriented programming for quick response to trends in managed care, as well as healthcare industry changes. MCO easily integrates with your existing infrastructure, leveraging your previous investments to achieve a greater return from your existing systems. This allows you to optimize returns on your current assets and cut costs for improved profit margins now and in the future.
