| |
|
|
|
|
| |
|
|
|
|
| |
Services
|
| |
The
M/Care System provides accurate, reliable, and |
| |
cost-effective access to Medicare entitlement verification |
| |
and
enrollment. |
| |
|
| |
Our
Services include: |
| |
- Online Eligibility and Enrollment System
- Batch Transaction Processing
- Batch Reporting
- Online Reporting
- Plan-Level Reports
- Reconciliation Services for PartC and PartD
- Internet Access
- Customized Reporting
- Customer Service
|
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
The Eligibility and Enrollment System System |
| |
The
online screens allow immediate access to eligibility information and |
| |
each
Plan’s membership data. The system also provides the ability to add |
| |
members,
delete members, and change transactions previously entered into |
| |
the
system. Various reports are also available for immediate viewing. |
| |
Reports
can be requested and immediately downloaded to the requestor’s |
| |
work
station. |
| |
|
| |
Batch
Transaction Processing |
| |
This
process includes the same CMS defined edits that our Eligibilty and |
| |
Enrollment system utilizes
and is used primarily for the submission of large |
| |
volumes of transactions.
Plans simply transmit a file to our system for |
| |
processing on our
mainframe computer. The transactions are processed |
| |
immediately and
a report is returned to the requestor identifying accepted |
| |
and rejected transactions. |
| |
|
| |
Batch
Reporting |
| |
Reports
available are: |
| |
- Monthly Accretion/Deletion
Detail
- Batch Transaction
error report
- Month-to-Date Transaction
Extract
|
| |
| |
| |
| |
Online
Reporting |
| |
Reports
available are: |
| |
- Rate Table Inquiry
- Accretion/Deletion
Status
|
| |
| |
| |
Plan-Level Files |
| |
Plan Level Data Files available are: |
| |
- Transaction Reply/Monthly Activity Data File- TRNDATA
- Monthly Membership/Data Format - MONMEMD
- Monthly Membership Summary/Data Format - MONMEMSD
- Part D Risk Adjustment Model Output Data File - PTDMODD
- Risk Adjustment Model Output Data File - HCCMODD
- BIPA 606 Payment Reduction Data File - BIPA606D
- Bonus Payment Data File - BONUSDAT
- Part B Claims Data File - CLAIMDAT
- Monthly Premium Withholding Report Data File - MPWRD
- 820 Format Payment Advice - PLAN820D
|
| |
Plan Level Reports available are: |
| |
- Transaction Reply/Monthly Activity Report (Monthly TRR) - TRNREPLY
- Part C Monthly Membership Detail Report
aka: Monthly Membership Report (MMR) - MONMEMR
- Part D Monthly Membership Detail Report
aka: Monthly Membership Report (MMR) - MONMEDR
- Monthly Membership Summary Report - MONMEMSR
- Part D Risk Adjustment Model Output Report - PTDMODR
- Risk Adjustment Model Output Report - HCCMODR
- Benefits Improvement & Protection Act of 2000 (BIPA)
606 Payment Reduction Report - BIPA606R
- Bonus Payment Report - BONUSRPT
- Demographic Report - DEMOGRPH
- Monthly Summary of Bills Report - SUMBILLS
- HMO Bill Itemization Report - BILLITEM
- Payment Records Report - PAYRECDS
- Plan Payment Report (APPS Payment Letter) - PLANPAY
|
| |
|
| |
Payment Reconciliation
Services |
| |
The
M/Care Medicare Payment Reconciliation System (RECON+ for |
| |
PartC and RxRecon for PartD) provides the necessary
reports to enable |
| |
Plans to easily reconcile their Medicare membership.
|
| |
|
| |
RECON+ and RxRecon uses Plan membership data and CMS membership |
| |
data to identify any discrepancies that can affect the payment from CMS. |
| |
RECON+ and RxRecon compares your membership data with CMS’s and |
| |
creates reports detailing all discrepancies found and the resulting payment |
| |
discrepancy.
|
| |
|
| |
Each
report lists all discrepancies found for a specific category by claim |
| |
number. The "Discrepancies In Payment Report-Detail" shows the |
| |
expected
payment from CMS and lists all discrepancy codes found for the |
| |
current
month. |
| |
|
| |
Internet
Access |
| |
Plans
can access our online Recon+ and RxRecon application from |
| |
any
PC through the use of a Browser. Just point and click to our site. The |
| |
data
you need when you need it either at home, at the office or on the road. |
| |
|
| |
Customized
Reporting |
| |
Plans
may request customized reports or special programming at very |
| |
competitive
rates. |
| |
|
| |
Customer
Service |
| |
M/Care
is the number one Medicare eligibility provider – it’s our goal not |
| |
only to
be the most successful but also the best. We are committed to |
| |
providing
you comprehensive and cost-effective solutions, legendary and |
| |
second
to none support, proactive, knowledgeable and customer-driven |
| |
team members. |
| |
|
|
|
| |
|
|
|
