Speed to market of new products and service improvement initiatives is an essential factor in the success of TPAs and others in the self-funded health benefits industry.  This includes a decision on whether to develop internally or use a subcontractor.  MCS currently completes vendor/business

 

Much of our success in these projects is based on our process, which is heavily weighted to defining the needs of our client, then measuring the ability of vendors to meet those needs.  Such needs assessment requires comprehensive knowledge of TPA systems, staffing, procedures and client base, as well as vendor capabilities.

MCS is able to assist any organization with selection and contracting in the following areas:

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• Core technology elements (claims system, population health management system, data warehouse and analytics, web portals);

• Claims cost control (Subrogation, Bill Review, Reference-Based Reimbursement, clinical review);

• Business Process Outsourcing (claims data entry/conversion, ID card production, post payment production, employee communications);

• PPO and carve-out providers; and

• Population health management (utilization management, case management, disease management, specialty drug management, wellness/prevention).

 

Independence is important!  MCS is compensated for vendor/business partner selection and contracting by its clients, and receives no compensation whatsoever from any vendor included in a selection process.  Recommendations are based entirely on the merits of the vendor and its contract related to client needs.