Claims Processing Module

• System Assisted Adjudication

The system determines adjudication according to eligibility, benefits and provider contracts.
 
 
• Integration With Utilization Management Module

MC/2000's Claims Processing Module is fully integrated with the Utilization Management Module, eliminating the need for redundant data entry.
 
 
• Claims Tracking

All claims can be entered into the MC/2000 system whether they are ready for payment or pending additional information. Individual line items on each claim can be processed seperately. There is no need to hold up payment of the entire claim for resolution of a single line item.
 
 
• Flexible Payment Selection

MC/2000 allows you to select payments to be processed by due date, insurance type, risk pool, entry batch, provider, carrier and member.
 
 
• Override Tracking

When an entry operator overrides the system adjudicated payment amount, the user and transaction are logged for audit purposes.
 
 
• User-Defined EOB Codes

MC/2000 allows you to define unlimited EOB codes and link these codes to actions such as void, pend, and deny. EOB codes can also be linked to correspondence to automate denial and request for additional information letters.
 
 
• Versatile Claims Inquiry

MC/2000 allows you to review claims by provider or member. Claims inquiry allows you to view claims that are currently being entered and clearly identifies claims in process.
 
 
• Extensive Reporting Capabilities

MC/2000 provides you with a full range of management reports and the capability to easily define additional reports.

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