SERVICES

Managed Care Professionals, Inc. (MCP) offers an array of third party reimbursement services to the healthcare industry for providers and payers. Our services include, but are not limited to, retrospective and concurrent underpayment and overpayment detection and collection, third party contractual allowance postings at time of billing, shadowing and correcting of client's system, and contract modeling and negotiations.

• Retrospective Underpayment and Overpayment Claim Review
  MCP provides a Retrospective Review of client third party contractual reimbursement including Managed Care, Blue Cross, and Government Payers. We identify and collect all underpayments and overpayments for the most recent two to three year period. This review is an important technique to monitor past and future contract performance, and collect previously unidentified revenue.
• Concurrent Underpayment and Overpayment Claim Review
  MCP provides a Concurrent Review of client third party contractual reimbursement for all payers, both Inpatient and Outpatient. MCP assures all potential or actual underpayments and overpayments are identified and collected (if necessary) in a timely manner, thereby increasing your cash flow. This service is performed both pre and post adjudication. Upon receipt of the initial third party payment, MCP immediately identifies, pursues, and collects all underpayments and overpayments. No incorrect reimbursement goes unidentified or uncollected. This ongoing daily review provides clients increased cash flow, improves overall days outstanding, and avoids any timely follow-up limitations present in many third party contractual agreements.
• Proprietary Software - Third Party Reimbursement Calculation Engine
  MCP's proprietary software, A Third Party Payer Calculation Engine and Adjudication System, provides an ASP solution to clients who recognize and realize the importance of being proactive and better prepared prior to the issuance or receipt of initial third party payments.
  
  Utilizing MCP's calculation engine, clients are assured that their expected payments are correct at time of billing. This pre and post adjudication service includes calculating and providing the accurate contractual allowance at time of billing for ALL Inpatient and Outpatient third party payers including Managed Care, Medicare, Managed Medicare, Medicaid, Managed Medicaid, and Worker's Compensation. MCP will correct and supplement client's in-house calculation engine, or become the sole provider of such function. This is an ideal alternative to assure all Inpatient and Outpatient third party reimbursement functions are monitored and reported accurately daily and ongoing.
  
  MCP requires a minimal data feed to accommodate our services. This data includes flat file uniform bills (UB04 or UB92, CMS1500), primary payer code and actual reimbursement or expected reimbursement, and a copy of the third party agreement.