The Managed Care Module is a valuable tool used to bridge the gap between an organization providing managed care services and a provider of care contracting to deliver services.  The ability to review contract requirements and authorizations allows a company to make informed decisions relating to total client care.

Administrative Benefits:

• Financial Planning

  • Use as a budgeting tool

  • Track Accounts Receivables

  • Track the value of outstanding authorization

  • Perform productivity analysis

• Contract Management

  • Negotiate contracts

  • Monitor profitability

  • Evaluate pricing and renewal strategies

  • Structure multiple authorization types

  • Monitor contract utilization

  • Renegotiate contracts

• Standard online reports

Clinical Benefits:

• Review benefits during treatment planning

• Relate service plan to authorization

• Remind of subsequent authorization

• Document authorization utilization

• Perform retrospective analysis of authorized versus provided treatment

Reimbursement Benefits:

• Use Benefit Wizard to give access to:

  • Client eligibility and benefits

  • Deductible, co-pay and other out-of-pocket expenses

• Bill authorized services

• Optimize rate of reimbursement

• Monitor coordination of benefits

• Track information necessary for resubmission and appeals

MANAGED CARE

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