HealthSoft Mcare™ is a fully functional and integrated information
system designed for the growing segment of new and emerging
risk-bearing managed care organizations. Because of the
number of plan variations and options with this ever-changing
market, Mcare is designed for flexibility with the ability
to benefit large group practices, Independent Practice Associations
(IPAs), Management Services Organizations (MSOs), Physician
Hospital Organizations (PHOs) and any other provider group
that is contracting with one or more health plans to provide
health care services to a specific population.
Organizations will find Mcare is one of the most cost-effective
medical claims adjudication and processing systems in
the market place developed to effectively manage health
plan contracts, pay medical claims, process referrals,
track individual eligibility, monitor individual or group
medical benefits.
Mcare is completely HIPAA compliant and has the ability
to electronically process all the ANSI standard transactions.
By developing strong partnerships with leading healthcare
IT vendors, HealthSoft brings a web-based presence so
organizations can check eligibility, submit referrals,
access referral info, submit claims and review statistics
of claims through a web portal.
Mcare™
System Features and Functions
- Network Provider Management
- Flexible Health Plan Benefit Management and
Administration
- Membership Services
- Capitation and Fee-For-Services
- Referral Processing
- Hospital Pre-Certification
- Claims Adjudication
- HIPAA Compliant
- Compliant and Grievances
- Provider Credentialing
- Case Management
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