Managed Care of America

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Can the system produce reports?
	Yes. Reports are generated using selectable criteria to allow the user to specify date ranges, specialties, providers, claim types, and many other criteria. The system essentially has an internal report writer that allows a set of fields to be combined by the user and output into predefined report formats. All reports can be previewed onscreen, sent to a file, or sent to a printer. Ad-hoc can also be accomplished. The selection is large and allows individuals with minimal computer skills to easily do multi-level reporting.
Does the system reprice claims?
	Yes. The Administrator™ permits input of claims manually, electronically, or via other media for input into a claims repository. During input, the system can check for referrals (i.e., gatekeeper models), utilize subscriber data to minimize input, check fee schedules to determine payments, and look up codes to automatically attach a description of service to the claim. The Administrator™ can produce complete repricing and referral reporting.
What is required for electronic movement of facility and practitioner claims? What is required for uploading and downloading from your system?
	The Administrator™ can communicate with virtually any system. In the case of a Managed Care Organization (MCO) and the payor, this is accomplished by programming a match between The Administrator™ software, residing at a client’s location, and the system of the payor (which has a wide range of possibilities). Claims data can then flow to the payor from the MCO to be used for their purposes. If an arrangement mandates that the payor initially receive claims from providers, the MCO can input claims and electronically transmit them to the payors or to a clearinghouse. Likewise, the system can support the direct electronic transfer of claims to the MCO from inexpensive PC’s at the provider locations.
Does The Administrator™ make payments/cut checks?
	No, The Administrator™ is not a claims payment system.
What coding systems can be used for repricing and facility claims?
	The system utilizes ICD-9 and CPT-4 procedural codes, and RBRVS and non-RBRVS fee schedules. It also permits DRG codes and user-defined codes. It supports “stop loss” or “threshold” claims processing.
How many codes can be entered for a claim?
	The system will allow an unlimited number of line items to be attached to one diagnosis, as well as to any specific claim. It allows for an unlimited of per-diem, discount, or case rate line items for facility claims.
Does the system handle Utilization Management/Utilization Review?
	Yes. The Administrator™ supports on-line pre-admission and pre-service authorization, and has automatic determination of eligibility and access to the patient’s current benefit plan information. Cert/auth numbers are system-assigned. The Administrator™ links the patient with provider along with extensive case notes and automatic user-defined flagging to provide case management of all or only ICD-specific case types. The system allows for admission management and concurrent review. Multiple decision-support devices, including the use of leading third-party databases (such as M & R) can be provided for the UM process.
How does the system track and report inpatient and ambulatory outcomes by provider?
	The system allows highly flexible reporting on all admissions, by admitting and/or discharge diagnosis that can be produced by clinical users who know what they want. Inpatient admissions and discharges can be tracked by status at discharge. Readmission for the same problem within a user-specified period of time by patient can be checked.
How can we reduce the increasing cost of producing letters?
	The Administrator™ includes a Letter Manager that automates this task. It automatically generates sets of letters for various events. Each topic can vary by distribution, custom comments, and letter text. It is formatted for easy fold-and-mail in a #10 window envelope.
Can the system handle multi-tasking and multi-users?
	Yes, the system is multi-user, allowing for 250 users per LAN. The usual operating system that links the workstations is Windows 2000 or Windows NT Server. We use a SQL platform. The system operates under all Windows environments. Multiple workstations can run simultaneously, usually utilizing Windows 98, 2000, NT, ME, XP at each workstation.
Can you make modifications to the system if requested?
	Yes. We recognize the wide variances in MCOs and their operations. Thus, we have developed a comprehensive software system. During our initial analysis, all customization will be identified, priced and included in the implementation work plan. It is our goal that all such customizations be identified prior to installation, but we realize that sometimes items pop-up at the last minute. If further customizations are needed, we can hold discussions, produce a cost estimate and work order, and then coding is executed and installed.
How is training accomplished?
	Our most successful training has occurred at locations where the client is fully aware of their work process and procedures and are committed to gathering pertinent, relevant questions for Managed Care Software (MCS). It can happen at your site or via Teleconferencing with dial-in, or a combination. We have a “help button” within our application so the user can access help as needed. We have found success with this application help file, along with our one-on-one 2-3 day training sessions.
Is there any kind of time stamping or transaction history available?
	Yes, username and day/time stamps are available in various modules.
What are your hours of support? Do you have a toll free support number?
	Telephone assistance provided by MCS is available between the hours of 9:00am and 5:00pm Eastern Standard Time, Monday through Friday, excluding holidays. Experience has shown that once installation and training are complete, the need for after hours phone support is greatly decreased. Our support line is toll free.
Do we pay any ongoing fee for maintenance after the installation is complete?
	We have a maintenance/license fee that is payable on a quarterly basis once the initial installation of the programs has been implemented and paid for. Maintenance/license fees are calculated as a percentage of the total sale price. Our license fee will allow MCS to grant a non-transferable license for the continued use of the software programs available via The Administrator™. This fee covers standard updates to the Programs, and reasonable application & technical assistance provided by telephone.
Does your product meet HIPAA compliance requirements?
	Our product meets the privacy standards required by HIPAA. To meet the claims standards, you will need a relationship with a clearinghouse such as Envoy. We provide Envoy’s NSF format with the software.