MedCost Benefit Services is relentless in our commitment to provide exceptional service. We serve with a results-oriented approach to benefits administration. Although we strive to excel in all areas of service, several stand out as truly unique:
Stability
We
have the resources to deliver on our promises. MedCost Benefit Services
is owned by MedCost, LLC. MedCost has been in existence since 1983 and
operates one of the largest managed care networks in the Carolinas. MedCost
is currently co-owned by Carolinas Healthcare System and North Carolina
Baptist Hospital. What does this mean to you? It means peace of mind,
knowing you are dealing with a secure and stable company that you can count
on for the long haul.
Integration
MBS clients benefit from our full service approach to administering
an employee health plan. Our services are seamless, integrated, and easy
to understand. The seamless integration results in a higher level of satisfaction
while effectively managing health care dollars.
MBS is a central source for:
- Medical Administration
- Dental Administration
- Disability Administration
- Stop-Loss Reinsurance
- Prescription Drug Programs
- Flexible Spending Account Administration
- COBRA Administration
- HIPAA Compliance and Administration
- Preferred Provider Network Services
- Utilization Management Services
- Cost Containment Services
Customer Service
The MBS Commitment
The same technology available to our claims analysts is used by our dedicated Customer Service Department. Plan participants and providers have one toll-free number to call with network and claims questions. Our representatives are experienced in customer service, claims processing, and network services, enabling them to resolve service issues typically during the initial conversation. Because all calls are documented online via a networked database, customer service representatives can view online documentation of previous calls from the same participant. This enables MBS to provide the highest level of customer service by providing instant access to previous conversations and service issues. To assure that accurate and professional service is being provided, customer service is monitored through real-time observance of actual phone inquiries. To ensure prompt and timely call resolution, our call center database tracks call response time, which is monitored daily. The result is unmatched customer service and satisfaction.
Technology
Investing for the Future
MedCost Benefit Services is committed to investing and reinvesting in technology systems. This commitment is your present and future assurance of efficient claims processing, rapid response to information demands and deadlines, and timely creation of procedures to keep pace with ever changing legislation. However, MBS recognizes that employee benefits administration is, at its heart, still a business of people serving people.
We remain dedicated to serving clients’ needs using technology
as a tool,
not as a replacement for the personal human touch.
We have invested in hardware and software technologies that incorporate every aspect of managed care into a streamlined claim processing system. This system includes electronic data interface (EDI) and workflow technology, allowing us to balance efficiency with effectiveness. This enables us to deliver accurate and timely services to our clients and also positions MBS for future growth.
Claims Adjudication
We equip our Claims Department with a modern claim processing system, which provides online edits for coordination of benefits (COB), preexisting conditions, subrogation, and “rebundling” of claims. These online edits result in considerable claim dollar savings for our clients. Claims analysts are supported by a management staff with an average of 19 years of claims processing experience. Our modern claim system, along with additional technological tools, ongoing training programs, up-to-date client information, and an experienced management staff empower our claims analysts to provide efficient and accurate claims processing.
Quality Measurements
Our constant overriding goals are to always exceed expectations; to deliver outstanding and professional service in every aspect of our relationship; and to do the right thing and do it right the first time.
To ensure superior service, MBS regularly measures results through our Quality Review Program. Our Quality Review Program ensures that efficient and cost-effective processes and procedures are in place and maintained. The program provides immediate, positive, and constructive feedback to our employees and also provides management with factual departmental quality performance measurements. These measurements enable us to recognize opportunities for improvement and provide feedback to our employees as they constantly strive to serve you better, faster, and more accurately.
Claims Processing Goals
- 99% financial accuracy
- 98% procedural accuracy
Administration Goal
- 95% accuracy
Customer Service Goals
- 90% of questions answered on first contact
- 30 second average speed of answer
- Call resolution within 24 hours
Cost Containment
Programs to Reduce Claim Dollars
MedCost Benefit Services has incorporated efficient processes that assist in controlling your healthcare dollars.
Claims Rebundling - MedCost Benefit Services utilizes the leading clinical editing software available in the marketplace. This editing tool reviews coding accuracy and appropriateness before claims adjudication, resulting in a reduction of overpayments or unnecessary payments to providers.
Auto-adjudication - We build our system to specifically correspond with the client’benefits plan design, increasing auto adjudication to up to 80% of all claims. This means we process our clients’ claims more accurately and efficiently. Further increasing our auto adjudication rate is the ability to upload all MedCost PPO claims directly from MedCost’s claim system, which represents over 85% of all medical claims. MBS is one of only two payors (TPA or insurance company) with direct upload ability from MedCost.
Network Management - MedCost Benefit Services utilizes the MedCost PPO network, which is one of the largest provider networks in the Carolinas. MedCost has the leverage to negotiate aggressive fee schedules, including per diems, global arrangements, and outliers. We also include separate transplant networks, which result in favorable outcomes for patients and substantial savings to healthcare plans.
In 2002, MedCost became the first independent PPO network in the Carolinas to achieve full accreditation by the American Accreditation HealthCare Commission/URAC for its provider credentialing procedures
Utilization Management - MedCost Benefit Services offers MedCost Health Management programs to our clients, which include Inpatient Precertification, Outpatient Review, Large Case Management, Disease Management, a Prenatal Program, and the 24 Hour Nurse Advice Line. Effective implementation and administration of these programs result in saving benefit dollars by reducing utilization, while maintaining a high level of patient satisfaction.
MedCost's Health Management Program has been accredited through the American Accreditation HealthCare Commission/URAC since 1994.
Standard
and Custom Reports -
MedCost Benefit Services uses Access report writer and query tool for
generating reports. This
query tool gives us
greater flexibility with user-friendly access to data. Because it is
Windows based, the user is able to export data into Excel format, where
we may manipulate the data to meet each client’s needs. Consequently,
you have a variety of choices. MBS can custom design your reports to
show information and to show exactly what you need.
A report may be individualized to reflect general summaries, or may be
specific
with
in-depth information.
