Table of Contents MCN's eServiceMCN’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 can access the current status of referrals, as well as upload records and 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
EChannelMCN’s eChannel - A web-accessible HIPAA compliant account is provided to physician Consultants which allows access to medical records and claim correspondence for all of their scheduled exams. Providers can upload voice files for transcription, review transcribed reports, electronically sign reviewed reports, update their credentials materials and review payment status.
Via fax - The network provider can transport claims information and cover letter questions, transcribed reports and payment information via fax to the consultant. This documentation is attached into the MCN system and can be viewed by the claims professional through his or her MCN eChannel account.
Andante platformPre screenting of providers
Provider mapping
Defined network
Credentials Maintained
Client profiles
Advanced Reporting
Pre screening of providersTo assure the provider has a history of timeliness and few issues regarding quality, the MCN Customer Service Representative can review the provider’s performance. The MCN system provides the number of completed exams or reviews over the past 12 months along with the number of exams where rework was required. In addition the data is provided on the average number of days until the appointment date and how quickly the provider completed the report for delivery to the client. This information is very helpful in scheduling exams that require tight time periods.
Provider mappingMCN tracks for many of its clients the specific mileage driven by the patient for a scheduled examination and delivers payment for said mileage or transportation. In many states it is the law to provide this service on certain types of claims. MCN can issue a check for travel costs with the appointment letter. MCN’s system integrates with Google Maps to not only provide an accurate reading of the mileage between the patient and the medical office, but also provide driving instructions to assist in the easy location of the facility.
Defined networkTo assure that a barred examiner is not used in association with a scheduled exam. MCN’s system has the ability to both exclude providers that the client has had service issues with in the past, or install an approval process where only those providers with certain credentials agreed to in advance by the client are available for MCN schedulers to select from. Should an MCN Customer Service Representative attempt to use a disallowed provider, a flag pops up blocking its usage
Credentials maintainedMCN 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.
Client profilesClient profiles allow for MCN to set up automated processes both at the client level and at the individual claims manager level. Such elements as; automating e-mails when there is a referral, claimant no-show notification, exam scheduled notification, completed report notification, or when records are missing near to the date of examination. These are only a few of the protocols that can be automated in MCN’s client profile feature. Our clients inform us that these protocols have helped eliminate human error for them as well as MCN staff.
Advanced reportingMCN measures every aspect of its operations from referral date to report delivery. These various elements can be made available for reporting purposes and customized to the clients needs. Here are some of the elements available for insertion in reports:
Referral Date
Scheduled date
Recruiting time (should the client wish MCN to recruit a new provider)
Appointment/review date from referral date
Dictation time
Transcription time
QA Time
Provider turnaround (exam to report delivery)
Total turn time
Driving distance
Reporting by specialty
Reporting by diagnosis
Reporting by product type
No-show reporting
Cancellation reporting
Provider reporting
These are just a few data points that clients may utilize to analyze their business with MCN. Let us help you design appropriate reporting for your needs.
Medical Bill Review/Decision managementMCN 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 our client-defined claims handling rules and automate the process through the use of decision management software. Our clients report dramatic improvement in claims management productivity, resulting in higher 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 clients obtain the maximum savings on every bill. MCN can assist the 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. Working in conjunction with your experience and criteria, our rules building team assures 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 call it an excellent tool 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. Our approach is on the leading edge. We look forward to working with you in implementing it for your claims.
Rules based MCN helps its clients develop a rules base for MCN’s Decision Management by taking manual and often unaddressed aspects of client operations and automate those elements. These client-defined rules have the capability of accessing other databases, instantly looking at medical bill histories and providing different types of actions based on decision findings. This may mean directing the medical bill to a specialist for additional processes and auditing or diverting the case medical or nursing management. MCN can work with your operations team to develop protocols that fit your specific needs. Rules can be based on any of the following elements and many more:
Diagnosis
Dates – of various types
Monetary maximums and minimums
CPT codes
Provider data
Provider history
Claims history and claims file information
Medical bill history
Benchmarking databases
Medical management databases
First report databases
SIU Databases
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