Contents - Index

Managed Care Organizations

Your relationship with MCOs is an extremely important one, and having a tight control on this relationship is very important.

MedFlex has many features that allow you to effectively manage this relationship.  For each MCO you do business with, you define what the allowable price for each procedure is.  When you create an invoice, it prints the form with your usual and customary prices (UCR) and makes ledger entries matching this.  Behind the scenes, another ledger entry is made writing off the difference between your usual and customary price and the primary carrier's allowable price.  As a result, your receivable numbers accurate at all times, rather than being overstated based on your usual and customary prices.

Payments in MedFlex are recorded by line item, allowing you to know exactly what each carrier is paying for each procedure code.  This lets you "tune up" your contract definitions and keep your receivable numbers accurate.  It also allows you to make decisions on whether or not to enter into new contracts since you know how each procedure and each carrier affects your cash receipts.

MedFlex has many other tools and reports which allow you to manage your relationships with MCOs.  Enclosed on the following pages are examples of some of these reports.  The first is the Top 50 Carriers by Cash Received.  This report lets you know which carriers are your most important based on how much cash you received from them over a given period of time.  The second report is Sales by Pay Source/Carrier.  The pay source is simply a way of grouping together related carriers (such as all your Blue Cross carriers) under one heading.  The final item is a graph of Cash Receipts by Pay Source.