From receipt to eligibility to negotiation and payment, we handle the entire claims administration process. Completely centralized, all claims, medical management and billing is handled in-house, allowing us to provide our clients with flexible and quick service with a personal touch
Claims Management
MTS specializes in protection and cost containment-proactively identifying and controlling your healthcare risk. With our in house medical management team we have a full service team to maintain and control your risk. With our internal auditing system, we have strict quality control practices in place to ensure your claims are paid properly the first time.
Risk Management
MTS utilizes a sophisticated predictive modeling program to identify high risk patients. Our team can strategize and prioritize patient populations, allowing patients to be categorized by illness, their severity and identify any gaps in care. Using the predictive modeling tool developed by Johns Hopkins, we are able to take your utilization data and identify patients whose health, functional ability and use of health services suggest they are good candidates for our care coordination program, eQCare. The result is better health for the patient and reduced costs.
Cost Containment
While most approaches to care management rely on telephonic interactions, eQCare is based on face-to-face patient engagements by our care coordinators. The care coordinator is linked to a high risk patient, and their interactions begin with in-person sessions. This high-touch approach is supported by our care coordination software that allows members of the care team to easily access medical information about a particular patient. This ensures consistent communications that lead to proper aftercare and follow-up. eQCare creates an integrated environment between the participant and all associated health care professionals. Communication is improved. Participation is enhanced. And, better results are achieved.
Here are some results that you might expect:
• Reduce hospital readmissions by more than 20%. • Return on investment ranging from 5:1 to 9:1. • Ongoing reductions in medical and pharmacy utilization.
* These results have been achieved for current clients
Care coordinators also live in the communities they serve. This approach builds strong bonds and creates positive behavior changes that lead to better health.
Utilization Review
Utilizing our experienced staff of Registered Nurses, Medical Directors, and a large panel of Board-Certified Physicians, unnecessary treatments and associated costs can be eliminated. To deliver the best care possible to members and to use healthcare dollars most effectively, it is critical to ensure that the care being delivered is medically necessary, appropriate, and aligned with clinical best practices. Typically this includeds but not limited to:
* Identify and monitor over-utilization and under-utilization of services; * Identify and monitor utilization patterns that: Compromise enrollee health and safety; Inappropriately use resources; or Create an organizational risk. * Evaluate consistent use of medical necessity including the: Criteria used; Information sources used for determination such as Clinical Practice Guidelines; and Review process used to approve the provision of services. * Review initial and ongoing eligibility determinations, and initial and continued service authorization decisions. * Provide support to other organizational functions. * Perform special targeted monitoring activities as required by regional need or regulatory mandate.
Online Enrollment
MTS offers a proprietary, secure website that manages employee benefit data online. Giving access to administration, tracking claims data, eligibility, as well as printing of temporary ID cards.
Cobra & HIPPA Administration
MTS speacializes in COBRA administration and can manage your COBRA program for you. From initial notice to termination, we ensure the entire process and all information is traceable utilizing our online website. Our clients are able to ensure timely mailings, maintain copies of notices mailed, maintain evidence of mailing, as well as provide proof that proper procedures were followed. The following are a listing of the services provided:
Initial Notifications of COBRA rights to active participants
Qualifying event notices
Bill, collect and remit COBRA premiums to the employer
Provide customized reporting options to include tracking, maintain and report all activities
Customized Reporting
Statistics are important, and in fact they can be valuable. But analytics are all about “actionability”. It is interacting with data, analyzing that data, then discovering and following through with the appropriate action. Analytics are about having the ability to look at all the surrounding context and understanding and identifying “why and how” you got somewhere and where you most likely will be going. To take any report at face value without reviewing the actual context is not helpful in knowing how you got to that point, and or how to manage your risk going forward. Our solution is nFORM, an interactive analytic package that integrates all healthcare data and eligibility into one reporting platform. Some of the main reports available are: