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System Features
IMPACT's features will improve operating efficiencies, reduce administrative cost, grow your business, and provide HIPAA Compliance. MCSI's clients realize a true ROI almost immediately after installing IMPACT.
MCSI's achievement was accomplished by focusing on efficient programming tools and technology, not by employing the lastest computer buzzword of the day. IMPACT routinely outperforms its competitors in benchmark tests during real-world claims processing evaluations requested by prospective customers. In other words, we are searching for the best solution, not the latest IT fad.
Auto-Adjudication
It's assumed that you are looking for a claim processing system that can actually automate the handling of health care claims, from receipt to payment, without manual intervention. Most systems make some attempt at auto-adjudication, but fall short in the process and must flag many claims for manual handling. Our target is 100% auto-adjudication!
IMPACT is the most complete auto-adjudication system you can find. We have yet to find a PPO pricing formula we cannot automate or a plan of benefits we cannot adjudicate, all automatically and without manual intervention. For example; DME rental rates up to the purchase value of the product? No problem. Variable mammogram limits based on the age and medical history of the patient? It's simple. Complex facility pricing based on DRG case rates including outliers and exclusions? We do it every day.
Applying our huge tool set of tables, rules and Boolean logic, IMPACT has walked away the winner in every bench mark exercise in which we have been asked to participate. We'd welcome the chance to show you how we do it.
How does this translate into a benefit for your organization? Simply by providing more accurate claim adjudication with fewer claim examiners. You do the math.
Automatic Pricing for all PPO Contracts
IMPACT can automate the pricing of ANY contract, regardless of complexity. After 13 years and 30,000 complex facility contracts, we have never been stumped.
When MCSI began, we realized from our past experiences that complex PPO pricing was a very difficult problem. We saw attempts at table driven solutions that never really worked. We saw pseudo programming attempts that were more difficult to use than writing computer source code. So we knew something better had to be invented. Then we struck on the idea of Boolean logic with powerful commands and started developing Med-Talk.
. Med-Talk is a clean and powerful tool that enables the user (or us, if you'd rather someone do it for you) to define any (and we mean ANY) PPO re-pricing formula. If you don't believe the ANY part, send us your worst PPO facility nightmare and we'll send you back a complete Med-Talk Module that handles it.
If there is a single feature that sets us apart from the other guys, this is it.
Auto-Assignment of Networks and Products
This is one of the hardest concepts to explain to the typical claim examiner that is accustomed to lesser systems. We are frequently asked early in the implementation process, How do I pick the provider's network? The answer is, you don't pick the provider's network; IMPACT does.
IMPACT allows you to assign a Network code and a Product code (a subset of the network) to all providers, employer groups and enrollment data. The selection of the proper Network and Product for each claim then becomes automatic in IMPACT. To determine the proper Network/Product for a specific claim, the system considers 1) compatible group and provider networks, 2) member enrollment rules, 3) product filters, 4) referral requirements, 5) pre-certifications, 6) PCP assignments, 7) on-call groups, 8) hierarchy codes and 9) other controlling activities. The correct Network/Product is always selected.
This process is so fool-proof in IMPACT that there is no way to manually select the Network. More importantly, we have never been asked to add an option to do so.
Customizable Data Entry Screens
All of our major database data entry screens are fully customizable to fit your specific needs. We have created a proprietary data dictionary that completely controls the drawing of all such data entry screens. That means member data, provider data, HCFA claims, UB92 claims, dental claims, pre-authorizations, etc., are all displayed with only those data elements that make sense to your business without the clutter of meaningless and confusing data elements. You decide how many ICD9 procedure codes you want to capture on your UB92's. You decide if your providers require three specialty codes, not two or four. When fully implemented, IMPACT fits your business, not the other way around.
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Powerful Database Search Tools
The ability to find the correct provider and patient is crucial to automating most claim-related workflows. Failing to find these entities results in manual review, duplicated records, and related inefficiencies.
The IMPACT system contains two powerful features that allow for high hit rates during claim processing, enrollment inloads, provider inloads, and other similar functions.
The first of these features is a robust scrubbing system founded on the USPS rules for addresses and business names. Built on top of that are the years of self-learning the system has acquired from processing millions of claims, member loads, provider loads, and requests for healthcare services review (pre-auths & referrals).
This robust scrubbing allows all incomming data to be compared, apples to apples, with the pristine database records in your system.
The second feature is a rule set that allows multiple searches to be attempted until a perfect match is found or until it is clear that no such perfect match is possible with the data provided.
A perfect match is ideal for many situations, certainly in claim processing, but knowing that a particular entity (be it a provider or a patient) is not in your system is also important so that you can be confident that you are not building a duplicate entry.
Coupling these two features yeilds extremely high hit rates as the cornerstone of highly automated processes.
Imports and exports
IMPACT is very astute in the area of importing and exporting data to and from other systems. Impact can export to a wide variety of text and database formats. This ability extends to all database tables including providers, employer groups, rates, and pre-authorizations (though the list does not end there).
In addition, MCSI has written dozens of custom imports and exports to and from external systems. While HIPAA-compliant formats are mandated and in wide-spread usage, custom interactions are still in common practice.
Interactive Web Based Customer Service Center
MCSI customers can access our secured Web Based Customer Service Center where they are able to perform many functions such as; 1) receive immediate program downloads, 2) review recent changes to actual IMPACT program source code, 3) search our Customer Service Knowledge Base for help and tips on system usage, and enter a chat room to discuss a variety of topics with MCSI staff and fellow IMPACT users.
Exclaim Web Interface
Impact data and business logic is available over the web through MCSI's Exclaim web interface. Providers, patients, and employers can access claims, enrollment and other information through a secure, brandable web portal. Exclaim is configurable to allow these different role types a distict menu of features and security levels. Allow your high-volume callers to self-serve!
And much more
IMPACT contains many more features. Please contact MCSI so that we can discuss the details of your requirements directly.
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