Provider and Facility Contract Experts

Claim Processing Experts | Health benefits administration | Electronic Data Interchange | Claims adjudication, HIPPA

EXPERIENCE:

MCSI has automated thousands of Provider Contracts. From the simplest of rate table based agreements to the most complex Hospital arrangement. In fact, we have been successful in automating every Re-Pricing contract ever presented to us.

Here are some of the Provider Contract complications that we experience regularly:

  • Fee For Service and Capitated Services
  • Medicare Based Rates and Rules
  • Case Rates and Outliers
  • Private Networks
  • Out of Area
  • On the Fly Out of Network Negotiations Workflows
  • Specialty Carve Out
  • Network Performace Analysis
  • Stop-Loss
  • Duplicate Handling
  • Real-time and EDI Claim processing
  • HIPAA Claim transactions, Coding and Messaging
  • Claim Routing to multiple Out of Network Partners