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MCN combines the largest and most comprehensive Medical Judgment Network with over 20,000 providers in the United States with the most advanced systems available in the industry. But ask our clients what they like about us and they will tell you they love MCN’s friendly service.
MCN’s greatest capital investment is in information technology. MCN is the clear technology leader in the field of Medical Judgment. We rely on information technology for internal and external communication and are constantly improving our hardware and software to meet client and operational goals. Our technology provides a robust tool allowing access in real-time to cases, consultants, clients and claimants. MCN’s web interface allows secure client and consultant access to our services.
Table of Contents MCN’s eService allows all referrals to be accessed whether they were made on-line, telephonically, via fax or mail. Through a secured web environment, clients access the current status of referrals, as well as the ability to upload records download completed reports and related case correspondence. All information is archived for ongoing access. Our clients tell us that MCN’s online service is the most efficient way they have to access information on a claim.
Let MCN provide an organized system to retain all of your information about your IME and peer review referrals.
MCN eService Features:
· Fully encrypted HIPAA compliant environment
· Referral Delivery
· Automated e-mail communications based on client protocols
· Records upload
· Referral status information
· Correspondence delivery and or archives (appointment and cover letters)
· Completed report delivery
· Invoice delivery
· Special requests (communications regarding the referral)
· Medical records storage and archival
· Robust search capability
· Claims history is maintained
· Supervisor access to all of client team data
· Client profile updates
MCN contracts with over 20,000 physicians nationwide to provide services on a case-by-case basis. We provide administrative and support services to include recruitment and credentialing of consultants, scheduling of examinations, records acquisition and preparation, report transcription, quality assurance of reports, and transmittal of written findings to the clients.
Aside from any introductory or educational contact with MCN, the first contact that MCN customers have with MCN begins with the Scheduling Department. In general, when making a scheduling call, or using the electronic methods below, the requestor has already made a determination as to the specific medical specialty they feel is most appropriate to address the particular injury or condition in question. However, if the claims professional needs assistance in making this determination, MCN staff is capable and experienced in helping with this. When the appropriate medical consultant is identified to address the customer’s needs, the appointment is scheduled. If desired, customers are provided with a copy of the physician consultants’ Curriculum Vitae. The system has the capability of verifying the location of the provider in relation to the claimant address.
MCN receives records, testing and other diagnostic information from its clients upon scheduling. MCN may obtain records through one of our Business Service Representatives who visit the client and may copy or scan documents. Some clients prefer our electronic data interface where imaged records are uploaded to MCN via a secured Internet connection. Still others prefer to mail or fax claim materials. We will work with you in the manner of your choosing.
Providers have access to our 24 hour dictation service which allows physicians to dial in and dictate reports telephonically to our transcription staff over an 800 number. Additionally, providers can deliver digital voice files to us via MCN eChannel. To facilitate completing the dictation MCN provides a web portal for our transcription. Transcription assignments are loaded into MCN’s HIPAA compliant transcription database with the appropriate templates and cover letters for the type of insurance and jurisdiction. Our transcriptionists download audio files that have been dictated by the consultants. Upon completion, the transcribed report is uploaded back into the system for processing by MCN’s Report Review department.
After the report has been transcribed the Report Review staff reviews the report to confirm that the physician has responded to the questions posed by the client and that the report meets MCN’s quality criteria. If in the report review process quality issues are noted, MCN staff follow-up with the consultant to address these issues. Once the physician has completed the report to MCN’s quality standards, the final report is sent to the physician consultant for their final review and signature.
MCN can track the specific mileage driven by the patient for a scheduled examination and delivers any reimbursable travel expenses for mileage or transportation. MCN can issue a check for travel costs with the appointment letter if requested. MCN’s system integrates with a mapping program to not only provide an accurate reading of the mileage between the patient’s home and the medical office, but also provide driving instructions to assist in easy location of the facility.
MCN uses a master database for primary source verification to confirm Board Certification, State licensure, residency training, medical school graduation and other data on our consultants. If the physician has had any reportable matters including licensure actions or malpractice settlements, we access the NPDB (National Practitioner Database) and review the specific facts to determine if the physician is a suitable consultant for MCN. MCN uses a “rolling re-credentialing” model. MCN may use consultant resources in remote areas or specialty types that are infrequently requested. It is imperative that these providers are fully credentialed prior to every evaluation to assure that they remain qualified for our Network.
Credentialing includes verification of: | | State Licensure – All state licenses are reviewed from each state in which the physician has practiced.
| | | Board Certification – Board certification is checked to determine if a Dr. is in good standing. MCN accepts Boards recognized by the American Board of Medical Specialties for medical doctors as well as several other Boards for non-MD’s.
| | | Professional Liability Insurance –MCN requires a proof of current insurance coverage.
| | | DEA License – MCN checks to confirm that the DEA license is in good standing. |
MCN utilizes the National Practitioner Database (NPDB) to review any adverse issues discovered in the credentialing process. Legal Proceedings – MCN utilizes the National Practitioner and State Databases to review and assess legal claims and disciplinary matters impacting a prospective consultant.
MCN brings efficiencies to medical bill review processing, with leading solutions for workers’ compensation and auto injury medical bill review.
MCN provides complete outsourcing through our Cost Management Service Bureau, offering solutions to fit each client’s need. With extensive EDI and scanning capabilities, MCN can provide a user-customizable workflow. We take client defined claims handling rules and automate the process through the use of decision management software. Our clients inform us of the dramatic improvement in claims management productivity, resulting in bill review accuracy and consistency.
The powerful decision engines use an extensive database of state fee schedules and the industry’s largest number of automated, national (and regional) PPO contracts to help you obtain the maximum savings on every bill. MCN can assist your claims manager’s workload by increasing workflow automation, getting the right bills to the right resources every time.
In the implementation process, MCN can conduct a study of physician payment history to aid in the selection of the most appropriate preferred provider by jurisdiction down to the zip code level. We make sure that the right provider is selected for the right state.
Do you have customers that want require Telephonic Case Management triage when a claim meets certain criteria? What about Utilization Review parameters? Our Decision Management program provides rules that trigger at key points in the claim process, helping you automate the identification of actions that need to be taken throughout the claim. Our rules building team, works in conjunction with your experience and criteria to assure that needs for these services are consistently identified and captured. We can automate actions that you choose in your own claims management process. Bill review customers who use our system find it an excellent vehicle for increasing efficiency and ultimately reducing the costs of conducting business.
MCN has developed this program in response to today’s need to go beyond Preferred Provider discounts and bill reductions. We are on the leading edge with our approach and look forward to working with you in implementing it on your claims.
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