Medical Bill Reviews

MCN’s Bill Review Service is a cost-effective product for our customers. The service, with multiple Electronic Data Interchange (EDI) interfaces, provides a customized workflow incorporating client-defined claims handling rules and automating the process through the use of decision management software. The results offer a dramatic improvement in claims management productivity, resulting in higher bill-review accuracy and consistency, and tremendous cost savings for our clients.

The software uses an extensive database of state fee schedules and the industry’s largest number of automated, national (and regional) PPO networks to help clients obtain the maximum savings on every bill.

In the implementation process, MCN will conduct a study of physician payment history to aid in the selection of the most appropriate preferred provider network by jurisdiction down to the zip code level. PPO configurations allow unlimited numbers of networks to be associated to a network.

Do you have customers who require Telephonic Case Management triage when a claim meets certain criteria? What about Utilization Review parameters? Our Decision Management program provides rules—personalized per client—that trigger at key points in the claim process, automating the identification of needed actions throughout the claim. Bill-review customers who use our system call it an excellent tool for increasing efficiency and ultimately reducing the costs of conducting business.

Cost Management Reviews

Cost Management Solutions are playing a growing role in controlling medical costs of Workers' Compensation and casualty claims. They combine all aspects of medical management for enforcement at the medical bill-review and payment level. MCN's Cost Management Solutions use sophisticated rules-based decision-management systems that employ clinical and jurisdictional claims criteria.  with the ability to access medical treatment benchmarks and other outside databases.

This customizable service allows clients to substantially reduce medical costs and claims staffing needs. MCN's ability to deliver warnings and workflow guides electronically to any platform (web-based adjuster portal, Electronic Data Interface [EDI], e-mail or fax) helps claims administrators improve their efficiency and increase savings.