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Insurance MasterCare™A new system used to effectively administer thousands of Managed Care OrganizationsPlease take a moment to learn how your organization can save time and money, and improve cash flow!MHIS has compiled full information on active Health Maintenance Organizations, Preferred Provider Organizations, Individual Practice Associations, Capitated Medical Groups and other Managed Care Organizations, across the United States. This information can be integrated with your patient registration and claims processing systems to reduce errors and improve cash flow. Administering several hundred different managed-care payors can be difficult. MHIS has created a software program and database to re-engineer your front office.
MHIS maintains all this critical informationThe provider's staff have instant access to the information. There is no need to spend hours tracking it down, editing and adding the information to your systems. Insurance MasterCare™The PayorID Data Warehouse can be fully integrated with your claims and registration system. You can utilize the Data Warehouse to update or edit the the claims office address, electronic clearing house codes, phone numbers and other information in your insurance master file(s). New payors can be added to your insurance master file. MHIS can develop custom interfaces to maintain the information in your McKesson, IDX, Siemens, Meditech or other claims registration system(s). Insurance MasterCare™Reviewing insurance company bulletins, manuals, and verifying addresses and telephone numbers is a never-ending task.It requires persistence, rules, procedures, classification systems, logic, management and a lot of time. It is a daunting task that often is put on the back burner when patients are being registered, computer systems modified, or claims processed by a busy facility. If the insurance master is not maintained, the consequences to the facility are very costly. If your registration staff have old data, old names, missing contract links, and/or incorrect phone numbers, they will not be able contact the right payor at the right time. Claims that are sent to the wrong payor without authorization are either denied or payment is delayed. The solution is to outsource the insurance master maintenance to a company that specializes in this critical task. Provider's Insurance MasterThe MHIS PayorID Data Warehouse is a national insurance master file. The classification procedures, rules, logic, coding structure and data management procedures enable MHIS to generate and update the unique insurance master file for our clients.-MHIS staff create the programs and the rules tables that map MHIS data into the client's own data format requirements.
MHIS Organizes Managed-CareMHIS staff devote thousands of hours each month reviewing hundreds of managed-care contracts, manuals and releases.MHIS compiles that information into its centralized data warehouse. MHIS maintains and updates the extensive information on managed care payors’ policies, procedures, administrative requirements and addresses into a single source. Your organization can save thousands of hours of staff time because, MHIS organizes the information from all the releases and manuals of the plans with which you contract, into a single source. In addition, MHIS has information on plans with which you do not contract. The MHIS files are expanded when a client contracts with a new managed care plan. The consistent format of all payor information saves staff time, increases contract compliance, and improves cash flow. MHIS compiles vital information on thousands of Managed Care Organizations. We are the authority on managed care! MHIS provides the detailed information that hospital admissions, billing, contracting, and utilization review staff need to administer so many different managed care plans. MHIS communicates the details via our data warehouse. Our comprehensive managed-care data warehouse is your single source to update your insurance master file(s) and staff.Data Management SystemConsistent database procedures, rules and standards enable MHIS to compile the only national payor data warehouse.Database management rules enable MHIS to collect, consolidate, annotate, integrate and distribute vital information on all managed care payors. MHIS has created a managed care classification system, which enables MHIS to issue rules for administering each Managed Care Organization. These rules are embedded into our data collection system and into our reference system called, PHind PayorsTM, (Provider Health insurance national directory) software system. Classification System
Aetna US Healthcare, Blue Cross, Cigna, and United Healthcare are just a few of the hundreds Managed Care Organizations which have multiple types of managed care programs. They each have their own HMOs, PPOs, indemnity, EPOs, Medicare Risk HMOs, health, workers compensation, and other programs.
Beech Street, CCN, and First Health are just a few of the hundreds of PPO contracting networks. Each of these contracting networks have hundreds (even thousands) of different insurers participating in their networks. To complicate matters even more, some payors participate with multiple contracting networks!
MHIS staff create separate records for each payor/network classification. Once a payor record is established, the classification system and rules guide collection of the appropriate data. Continuous Data ReviewThere are thousands of changes to the database each month. Payors change their address(es) and phone number(s). Managed care networks come and go. Payors modify their administrative requirements. Additional insurers and employers are added to the MHIS service.MHIS reviews the releases and bulletins of the plans and issues new information. MHIS keeps abreast of the changes in insurers, payors, agents, contracting providers, employer health plan options, phone numbers, addresses, and other information. MHIS uses national telephone directories, address check systems, magazines, newspapers, the internet, and industry publications to stay on top of payor changes. Payors are contacted periodically to verify the correct information. The Managed Healthcare Information System Data Warehouse simplifies the administrative process for your facility. MHIS staff compiles the information and monitors health and / or workers compensation coverage from Managed Care Organizations, Governmental and Indemnity Payors in all 50 states. The Data Warehouse includes over:
MHIS DatabaseEvery payor record is maintained by MHIS. Insurer information available in the MHIS PayorID Data Warehouse includes:
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