Utilization Management Module

• Detailed Tracking Of Specialty And Hospital Referrals

With MC/2000's Utilization Management Module you are able to monitor referrals from inception to closure. As a result of the user-defined status codes, you have the ability to view all actions relating to a specific referral.
 

• Pre-adjudicate To Determine IBNR

MC/2000 is able to determine potential liability of each service being authorized by checking the provider contracts and calculating the expected payment. This feature allows you to realistically forecast your cash obligations.
 
 
• Automated Referral Process

MC/2000 has a fully automated referral process. Working in conjunction with the Benefits of Insurance Module, MC/2000 allows you to control the authorization of services based on the rules you establish.
 
 
• Multiple Providers per Authorization

Multiple providers can be specified for each authorization, simplifying case management. Authorizations can also be amended to include additional services if determined necessary. Status of the authorization is tracked through the individual line items.
 
 
• Hospitalization Tracking

MC/2000 provides you with the ability to track hospital bed days at multiple levels of care.
 
 
• Anticipated vs Actual

MC/2000 provides you with the actual services rendered while retaining the anticipated services, thereby alerting you of higher risk potential.
 
 
• Complete Integration

MC/2000's Utilization Management Module is fully integrated with other MC/2000 modules, including Benefits of Insurance and Claims Processing.

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