Managed Care Organization

SmartCareMCO is an integrated module to manage, communicate, collaborate, and pay external service providers. Outside providers will have full clinical functionality for better case management and outcome measurement with the contracting agency.

Dashboard

In Streamline SmartCareMCO, the dashboard consists of the following information:

  • Members currently hospitalized
  • Members that did not meet monthly deductible
  • Members served over the last 12 months
  • Claims without complete information
  • Claims to be adjudicated
  • Claims pended for over 30 days
  • Claims where payment is overdue
  • Claims to be worked
  • Claims to be paid
  • Total number of provider contracts
  • Providers where contract is expiring in 90 days
  • Number of contracts that have reached 90% of their cap
  • Scheduled Events (hospitalizations, discharges etc.)
  • Alerts and Messages

Managing Providers

  • Contracts and Rates
  • Credentialing
  • Site Review
  • Provider search for member referral

Managing Members

  • Demographics
  • Plan Eligibility
  • Hospitalization tracking
  • Scan/upload or directly enter required information

Utilization Management

  • Authorization tracking
  • Hospitalization Pre-Screen
  • Hospitalization Concurrent Review
  • Hospitalization Discharge
  • Tools to document UM review of authorizations and justification for approved services which meet URAC standards
  • Capitated plan management

Claims Processing

  • Claims entry
  • Receive 837 electronic claims
  • Claims adjudication processing
  • Claims payment, check processing and RA distribution
  • Refund and credit management
  • RA/835 distribution
  • Integrated payment and/or GL system

Provider Access

  • Member Demographics
  • Member Eligibility
  • Track Authorizations
  • Complete services/ Upload Claims
  • Generate Payment Reports

Want to know more? Contact us

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