MCO Central Platform

MCO Central is a first-of-its kind Web-based platform for developing and deploying end-to-end workers' compensation claims management systems that can be implemented either as hosted solutions or as on-premise solutions. MCO Central helps compensation providers to process workers’ compensation claims—from the first report of injury through case management, note entry, bill processing and payment, and reporting while ensuring financial accountability. By streamlining claim handling, MCO Central enables customers to realize considerable cost advantages, reduce claims processing turnaround times, and achieve higher customer satisfaction.
 
MCO Central brochure 

Features

Injury Reporting
Injury information is captured over the Web through First Report of Injury (FROI) forms that comply with reporting formats for a number of states. FROI reports can be electronically transmitted to state bureaus in the required templates. Further details for investigating injuries that are acquired through additional follow-up can also be captured and tracked.
 
Bills processing
Extensive capabilities for processing provider bills and payments help streamline procedures while lowering costs. Clinical editing rules make it easier to handle provider bills. A first-level automated bills review and auto adjudication takes care of most claims, which enables customers to focus on larger and more complex cases.
 
Case management
Including both short term and long term case management, MCO Central helps coordinate treatment, rehabilitation, and return to work. Systematic tracking of therapy and results, as well as patient status, enables effective costs control. Seamless integration with electronic health records systems makes it possible to directly extract information for review of cases.
 
Financial accounting
Financial accounting functionality helps keep track of expenses information, which can be directly transferred to the current accounting systems. Capabilities include import of bank statements, balancing of books, and reconciliation of statements at the end of every month.
 
Performance benchmarks
Features such as provider rating help enhance timeliness and quality of treatment, while lowering cost. By holding national return to work benchmarks, MCO Central enables the comparison of performance vis-à-vis benchmarks and also helps build internal benchmarks.
 
Workflow Capabilities
Workflow processes distribute claims information to appropriate individuals for review. Timely alerts on large loss claims will ensure appropriate response and effectual costs control. An automated database driven EDI utility ensures on-time data transmissions, including a ‘changes only’ transmittal for all subsequent data thereby lowering bandwidth requirements. Seamless communication of regulatory filings is achieved through the EDI interface. 
 
Benefits
  • Fewer data entry errors resulting in higher data quality
  • Faster settlement of claims and bills with streamlined processes
  • Improved quality of service to workers and providers
  • Lower cost of treatment due to better information
  • Strengthened regulatory compliance through automated reporting
  • Speedier return to work for injured workers.