About Us

Medicare Managed Care represents nearly one-third of all Medicare beneficiaries, with annual enrollment growth of over 8%. Meanwhile, many states are transitioning to Medicaid Managed Care for long-term care patients.

The administration of skilled nursing facility (“SNF”) residents enrolled in Managed Care Organizations (“MCOs”) significantly impacts staff resources and negatively affects payment rates and cash flow.

To mitigate the stress of MCO management, turn to Case Management Solutions. Our powerful, proprietary MCO Manager™ software and highly trained professionals ensure you receive optimal reimbursement while reducing your operating costs.

Our comprehensive, fully scalable outsourced solution is the answer to the challenges of operating in a growing Managed Care environment!

Services & Benefits

    Our comprehensive mco solution Includes the following services

  • HMO/MCO Case Management
  • Real-Time Authorization Tracking
  • Insurance Verification
  • High Cost Contract Exclusion/Outlier Capture (Medications, Specialty Mattresses, Wound Vacs etc.)
  • Out-Of-Network Authorizations
  • Medicare “Part B” Authorizations
  • Denial Management and Claim Appeals
  • Secondary/Co-Payment Authorizations
  • Live MLTC/MLTSS Authorizations and Tracking
  • Contract Review/Negotiation
  • Monthly MCO Billing Reconciliation
  • ISNP Oversight/Reconciliation

    The benefits of using cms include:

  • Increased Revenue
  • Reduced Staffing Costs
  • Increased Staff Productivity
  • Enhanced Medicare Part A Days by “Rationalizing” MCO Enrollment
  • Increased Length of Stay
  • Higher Authorized Levels
  • Reduced Denials
  • “Cleaner” Claims
  • Streamlined MCO Processes
  • Enhanced IDT/Billing Communication
  • Detailed Monthly Trend Tracking and Utilization Reporting

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