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Managed Care |
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CureMD managed care innovated base delivers innovative features and proven functionalities for Managed Care organizations. CureMCS helps managed care organizations ensure adherence to preventive care guidelines, while allowing them to determine the medical necessity for care services.
The system also ensures effective care delivery through enforcing adherence to payer plan guidelines to help reduce care delivery costs and health maintenance overheads, while ensuring fraud reduction and overall process integrity.
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| Features |
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Patient Care
- Preventive care
- Medical necessity determination
- Supplemental diagnosis
- Coverage Determination Automation
- Coding Initiatives
- Modifiers
- Risk assessments
- Clinical suggestions
Information Management
- Insured person
- Dependents
- Member Enrollments
- Clinical Information management
- Risk assessment
- Suggest/allow more treatments
- Policy recommendations
- Accumulators (Plans, Benefits, Carriers, Employer groups)
- Groups/Employers information
- Provider information
- Provider Credentials
Claim Processing & Adjudication
- Electronic data interchange
- Paper Claims acceptance
- EDI engine
- Claim processing
- Billing Rule management
- Electronic Remittance Advices (ERA)
- Paper EOB
- COB cycle for claims
- Crossovers of different payers Connectivity
- Rejection reason codes
Follow-up Action Codes
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Customer Relationship Management
- Business Intelligence
- Comprehensive Activity Management
- Provider Lead Management
- Comprehensive Provider Qualification Tracking
- Medical Facility Tracking
- Dynamic Worksheets and Pivot Tables
- Administrative Dashboards
- Form Generation, Interpretation and Distribution
- Advanced Lookup for medical facility and providers
- Merge and De-Duplication Processing
- Remote Accessibility
Management/Reporting
- CureMD provides customizable reporting engine that can facilitate in generation of any kind of reports from existing information
User Management/Administration
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CureMD provides a controlling mechanism of application through its user management that all the operations that can be performed by the application can be monitored and have access rights.
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| Benefits |
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- Managed Care organizations can easily define and manage the plethora of medical necessity guidelines aimed at identifying services that are necessary (and unnecessary) for patients with specific diagnoses.
- Due to the diversity of payer-specific medical necessity guidelines, it is often very difficult for providers to remain compliant which results into denied claims and loss of revenue.
- Medical necessity management can help HMO's determine the necessity for services that required by specific patients for certain diagnoses.
- Based on the patient’s diagnosis, past medical history, disease pattern and risk assessment the system can automatically determine the eligibility for treatments that are:
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Reasonable: provided with appropriate amount, frequency and duration, and accepted standards of practice |
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Necessary: appropriate treatment for the patient's diagnosis and condition. |
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Specific: targeted to particular treatment goals |
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Effective: expectation for improvement within a reasonable time |
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Skilled: require the knowledge, skills and judgment of a specialist |
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| Return on Investment |
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As Managed Care organizations grow, and regulatory and reporting requirements increase, they find that the time required to manage the care plans and guidelines is consumed by the need to collect and manage patient eligibility data, correct errors, complete paperwork and other repetitive tasks. As a result, efficiency decreases and operational costs increase, forcing organizations to become more efficient without sacrificing the effectiveness, accuracy and profitability of their business process.
CureMD’s Managed Care system automates the process of verifying the eligibility of patients for rendered services, and documenting and reporting that information, thereby streamlining workflows and optimizing efficiency; and enabling organizations to reduce operational costs, minimize staff and administrative overheads and maximize returns.
CureMD envisions that Managed Care organizations using CureMCS can maximize their ROI through:
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- Accurately assessing patient eligibility.
- Minimizing operational costs by replacing costly and time-consuming manual management of information.
- Increase administrative productivity.
- Monitoring patient care and progress in a timely fashion.
- Analyze utilization patterns.
- Streamlining the benefits determination process by having accurate service delivery information.
- Enhancing fraud detection and reporting
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