Best in class savings coupled with superior risk management

MCA has a vast proprietary database of reimbursement data that is utilized during the negotiation process. We create a negotiation band utilizing Medicare reimbursement as a base. A variety of factors and metrics are taken into consideration in determining the final reimbursement. Our team works to obtain a mutually agreed upon settlement, realizing the best savings without jeopardizing member satisfaction. A key element to our process is that once an agreement is finalized we obtain 100% sign off from every provider on every single negotiated claim. Each signed agreement is shared with the Payer and we archive all Agreements.

MCA can utilize a funding mechanism that allows for prefunding or funding at the point of negotiation. If a future encounter with a provider has been or will be established in a specified time frame we can pre-negotiate discount for the service. If a claim has already been generated then we can offer funding at the point of negotiation. This approach is typically utilized for certain high dollar claims and it usually will elevate the discount.

MCA applies medical and reimbursement edits. Registered nurses and physicians manage the audit process. This is a line-by-line review of the claim. An in depth review of all medical records is performed.