Manage all aspects of behavioral care from one powerful platform

Now you can bring together all the diverse functions of your Managed Care Organization (MCO) under one system. AlphaMCS tracks member demographics, provider performance, applications and contracts, service referrals and provision along with provider monitoring — all in one end-to-end solution.

You can access the system from virtually any browser, anywhere you’re on the Internet. You can also work off-line and sync your data when you return to an Internet connection. This hosted environment eliminates maintenance hassles, is updated continually and makes it easy to resolve any problem you may be having.

AlphaMCS Features

Patient ManagementManaged CareService Provider ManagementClaims ProcessingQuality ManagementProvider Agency PortalReportingCare CoordinationEDI
  • Patient Demographics including NC CDW elements
  • Benefit Information
  • Coordination of Benefits for Third Party Payers
  • Clinical Designations
  • Clinical Home Tracking
  • Problem List (ICD-9CM)
  • Substance Abuse History
  • Crisis Plan
  • Treatment Plan (PCP) Upload
  • Referring Provider Tracking
  • Chart Notes
  • Enrollment Status and Source tracking
  • Services History
  • Referral History
  • Ability to process/create 834 and process 820 Eligibility files in 5010 format
  • Ability to send and receive 270/271 files in 5010 format

 

  • Call Management and referral appointment tracking based on location, specialty and contracted services provided.
  • Screenings Documentation including NC specific STR
  • Service Authorization Request tracking
  • Utilization Review Documentation and Audit Record
  • Industry Specific needs assessments including LOCUS/CALOCUS, ASAM and SIS.
  • Treatment Plan Tracking including NC specific PCP.
  • Track Hospitalizations
  • Manage Admission and Discharge into Services
  • Manage and Track target population groups
  • Ability to allow unmanaged visits
  • Client Budget Tracking, including NC Innovations specific requirements
  • EPSDT Tracking
  • Wait List tracking and Waiver slot management
  • Slot Scheduler

 

  • Service Provider Demographic tracking including sub-sites
  • Contracted Services tracking
  • Contract limit tracking
  • Specialty and Preference tracking
  • Negotiated Rate Tracking
  • Clinician Tracking
  • NPI and Taxonomy Mapping

 

  • Automated Rules based claims processing with configurable rules
  • HIPAA Compliant claims submission including Direct Data Entry and 837P/I in the required 5010 format.
  • 997 response file creation
  • Claims Management screens with the ability to reprocess and the ability to change claims processing results with permissions
  • Claims random audit sampling
  • Accounts Payable System Integration including integration to Dynamics GP.
  • Shadow Claims Processing
  • 835 and Electronic Remittance Advice generation
  • Industry Standard HIPAA compliant reason and remark codes.
  • Generation of 837P/I of clean claims for reporting to third party payer including IPRS and NC Medicaid.
  • Sliding fee scale and client deductible tracking
  • Benefit Plan maintenance
  • Clearinghouse claims routing
  • Void and Replacement Claims Processing
  • MUE (Medically Unlikely Edits)
  • Medicare Override Processing
  • SFTP of Claims related files
  • DRG processing
  • Payback and Recoupment processing

 

  • Complaint Tracking and Resolution Workflow

 

  • Direct Data Entry Claims Submission including CMS-1500 and UB-04
  • Service Authorization Request and Status Tracking
  • Enrollment and Referral Request including NC specific STR
  • Treatment Plan Submission including NC specific PCP
  • Crisis Plan Submission and Retrieval

 

  • Canned Reports built in SSRS
  • OLAP Data cubes used for Dashboard and KPI’s

 

  • Progress Notes specifically PIE
  • Treatment Plan Creation including NC specific PCP
  • Treatment plan reviews
  • Consent Tracking

 

  • 837P/I incoming and outgoing
  • 835 incoming and outgoing
  • 997
  • 834 and 820 processing
  • 270/271

 

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