Managing Care

The Clinical Manager™ provides Managed Care Organizations (MCO’s) with the tools to authorize services, track service utilization and reimburse providers. A sophisticated reporting system allows for highly detailed reporting and useful summaries.

Pre-Authorize Reimbursable Services – Through the integrated plan of care, service coordinators may authorize services by vendor and provider. Each authorization calculates the cost of the authorization using the provider’s approved reimbursement rate for the proposed service. The system can match providers with proposed interventions using a variety of criteria.

Claims Reimbursement – Claims submitted for reimbursement may be matched with authorizations in the plan of care before payment is made. Contracted service providers may be given limited remote access to enter claims online, eliminating the exchange of paper.

Service Utilization – A number of reports provide MCO’s with utilization data that summarize costs and units of service in a variety of ways