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System Features
 IMPACT's features will improve operating efficiencies, reduce administrative cost, grow your business, and provide HIPAA Compliance. MCSI's clients realize a true ROI almost immediately after installing IMPACT.
MCSI’s achievement was accomplished by focusing on efficient programming tools and technology, not by employing the lastest computer buzzword of the day. IMPACT routinely outperforms its competitors in benchmark tests during real-world claims processing evaluations requested by prospective customers. In other words, we are searching for the best solution, not the latest IT fad.
Auto-Adjudication
It's assumed that you are looking for a claim processing system that can actually automate the handling of health care claims, from receipt to payment, without manual intervention. Most systems make some attempt at auto-adjudication, but fall short in the process and must flag many claims for manual handling. Our target is 100% auto-adjudication!
IMPACT is the most complete auto-adjudication system you can find. We have yet to find a PPO pricing formula we cannot automate or a plan of benefits we cannot adjudicate, all automatically and without manual intervention. For example; DME rental rates up to the purchase value of the product? No problem. Variable mammogram limits based on the age and medical history of the patient? It’s simple. Complex facility pricing based on DRG case rates including outliers and exclusions? We do it every day.
Applying our huge tool set of tables, rules and Boolean logic, IMPACT has walked away the winner in every bench mark exercise in which we have been asked to participate. We’d welcome the chance to show you how we do it.
How does this translate into a benefit for your organization? Simply by providing more accurate claim adjudication with fewer claim examiners. You do the math.
Automatic Pricing for all PPO Contracts
IMPACT can automate the pricing of ANY contract, regardless of complexity. After 7 years and 30,000 complex facility contracts, we have never been stumped.
When MCSI began, we realized from our past experiences that complex PPO pricing was a very difficult problem. We saw attempts at table driven solutions that never really worked. We saw pseudo programming attempts that were more difficult to use than writing computer source code. So we knew something better had to be invented. Then we struck on the idea of Boolean logic with powerful commands and started developing “Med-Talk”. And, it actually worked. Med-Talk is a clean and powerful tool that enables the user (or us, if you’d rather someone do it for you) to define any (and we mean ANY) PPO re-pricing formula. If you don’t believe the ANY part, send us your worst PPO facility nightmare and we’ll send you back a complete Med-Talk Module that handles it.
If there is a single feature that sets us apart from the other guys, this is it.
Auto-Assignment of Networks and Products
This is one of the hardest concepts to explain to the typical claim examiner that is accustomed to lesser systems. We are frequently asked early in the implementation process, “How do I pick the provider’s network?” The answer is, you don’t pick the provider’s network; IMPACT does.
IMPACT allows you to assign a Network code and a Product code (a subset of the network) to all providers, employer groups and enrollment data. The selection of the proper Network and Product for each claim then becomes automatic in IMPACT. To determine the proper Network/Product for a specific claim, the system considers 1) compatible group and provider networks, 2) member enrollment rules, 3) product filters, 4) referral requirements, 5) pre-certifications, 6) PCP assignments, 7) on-call groups, 8) hierarchy codes and 9) other controlling activities. The correct Network/Product is always selected.
This process is so fool-proof in IMPACT that there is no way to manually select the Network. More importantly, we have never been asked to add an option to do so.
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Customizable Data Entry Screens
All of our major database data entry screens are fully customizable to fit your specific needs. We have created a proprietary data dictionary that completely controls the drawing of all such data entry screens. That means member data, provider data, HCFA claims, UB92 claims, dental claims, pre-authorizations, etc., are all displayed with only those data elements that make sense to your business without the clutter of meaningless and confusing data elements. You decide how many ICD9 procedure codes you want to capture on your UB92’s. You decide if your providers require three specialty codes, not two or four. When fully implemented, IMPACT fits your business, not the other way around.
Powerful Database Search Tools
An integral part of any claim processing system is its ability for find the proper provider, patient, employer group, claim, pre-authorization, etc. IMPACT has the luxury of using a sophisticated search tool called Aimdex (Associative Indexing Method). This software feature lets IMPACT find records instantly using a combination of search keys simultaneously. Why is this good? You’ll know when your claim data entry staff is searching for the correct record from their data base of 500,000 providers, while 50 other operators are busy entering claims and batches of EDI claims are being loaded. In such a scenario, IMPACT can promise sub-second response times to return all occurrences of all doctors (for example) whose last name is Wilson and have 8765433 somewhere in their tax id (the rest was smudged out) and whose address started with 3243 Main St.
More importantly, these search abilities allow IMPACT to achieve an extremely high percentage of good hits during EDI searches. One of our clients, with over 1 million provider records, was able to fine tune their database and search rules to receive a hit rate of over 90% while searching for facility records. You should expect the same.
Imports and exports
No system can outperform IMPACT in the area of importing and exporting data from or to other systems. We can convert your entire enrollment database, or any part of it, into an ASCII text file in a matter of minutes. Same with your providers, employer groups, rates, pre-authorizations, and any other database (there are over 150 active databases in IMPACT) in the system.
In addition, MCSI has written over 170 custom imports and exports to external systems over the last 6 years. So you have a custom enrollment file you receive from your brother-in-law’s company (think he cares about X12-834 formats?) and you need to apply it to your member database on a regular basis? No problem, we can usually have it running in a day or two. And if we know about it up front, the programming will be included in the price of the system. We’re absolutely arrogant about our import/export capabilities.
Interactive Web Based Customer Service Center
MCSI customers can access our secured Web Based Customer Service Center where they are able to perform many functions such as; 1) receive immediate program downloads, 2) review recent changes to actual IMPACT program source code, 3) search our Customer Service Knowledge Base for help and tips on system usage, and enter a chat room to discuss a variety of topics with MCSI staff and fellow IMPACT users.
And much more……
IMPACT contains so many features that listing them all here would just insure that you, the reader, would get tired and quit reading this before you got to the end. But since you’ve been patient enough to read this far, let me suggest to review two other documents attached to this web site. The System Overview and the Check List, both available in either Word or Adobe versions, are located in the System Overview section.
We think a properly configured system should be so automatic that even a baby can run it.
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