Switch to the Web-Based Behavioral Health Solution built for MCOs
- Patient Management
- Managed Care
- Service Provider Management
- Claims Processing
- Quality Management
- Provider Portal
- Reporting & EDI
- Capture patient demographics through multiple entry points
- Handle multiple benefit plans under each insurance plan
- Receive and update Coordination of Benefits (COB) information during enrollment, through provider updates or from the consumer
- Designate specific clinical disabilities under each insurance / benefit plan
- Implement assignment and tracking Clinical Home designations
- Classify patients under the latest ICD10-CM standards (International Classification of Diseases, Tenth Revision, Clinical Modification)
- Capture and store the current status and history of consumer substance use based on the Insurance / benefit plan required data
- Enable consumers to have crisis plans or treatment plans uploaded to you by their provider or by your staff
- Capture and store Release of Information and other consents that a consumer has given
- Store and validate primary care providers for appropriate consumers and validate claims processing against this information to ensure that appropriate referral procedures are followed
- Provide the ability to take notes for care coordination, utilization reviews and call notes that will become a permanent part of the client’s chart upon proper approval
- Capture and store the current enrollment status of your consumers
- Collect and track all service history through authorization request, final authorization, and claims activity
- Track all provider referral information captured in screening, triage and referral processing
- Process or create 834 and process 820 eligibility files. Send and receive 270/271 files in 5010 format.
- Manage calls and track referral appointment based on date, keyword search, location, specialty and contracted services provided
- Make member enrollment a breeze
- Support an electronic Service Authorization Request (SAR) that can be submitted to you from a provider through the Provider Portal
- Provide utilization review documentation and an audit record
- Capture level of care and support needs assessment results, including LOCUS/CALOCUS, ASAM and SIS
- Track treatment plans inside your clients’ charts
- Manage admission and discharge into services
- Manage and track target population groups
- Allow unmanaged visits
- Capture, store, and update your consumers’ budgets
- Allow providers to tag any request for service of a Medicaid child that is outside of the standardized limits under the Medicaid Benefit Plan
- Create wait lists and gain waiver slot management tools
- Provide your call center with a robust appointment and referral scheduler
- Track service provider demographics, including sites
- Manage your contracted services in one place
- Specify capitation by provider through contract set-up
- Capture, store and retrieve your providers’ specialties and preferences
- Manage client specific rates and services at the contract level
- Maintain a clinician tracking and linking process
- Store your Providers’ and the individual clinicians’ National Provider Identification (NPI) numbers and taxonomy codes
- Electronically track credentialing and provider application information
- Automate your claims processing with configurable rules
- Allow for HIPAA compliant claims submission, including direct data entry and 837P/I in the required 5010 format
- Create 999 response files
- Reprocess and change claims processing results based on user permissions
- Generate random claims samples for auditing purposes
- Integrate with your accounts payable system
- Process shadow claims
- Generate 835 and Electronic Remittance Advice
- Use industry standard HIPAA compliant reason and remark codes
- Generate 837P/I clean claims for reporting to third party payers
- Allow for a sliding fee scale and track client deductibles
- Manage multiple benefit plans
- Route clearinghouse claims
- Process void and replacement claims
- Incorporate MUEs (Medically Unlikely Edits)
- Allow for certain services to be directly billed by designating services known to not be covered by Medicare or other insurance plans
- Securely transfer claims and related files through SFTP (secure file transfer protocol)
- Process paybacks and recoupments
- Enable grievance and incidence tracking
- Provide resolution workflows
- Capture provider measures specific to each insurance / benefit plan
This web-based provider agency portal provides a secure, password protected access to AlphaMCS for providers who hold a business agreement with you.
- Direct Data Entry Claims Submission including CMS-1500 and UB-04
- Service Authorization Request and Status Tracking
- Enrollment and Referral Request
- Treatment Plan Submission including NC specific PCP
- Crisis Plan Submission and Retrieval
Canned Reports Built in SSRS
The AlphaMCS solution includes pre-determined reports in the AlphaMCS database Reporting Module. These reports will be developed to incorporate the major Performance Indicator requirements in your contracts.
Replicated Database for Local Reporting
Mediware will work with you to set up a local server to download the AlphaMCS data for local ad hoc and drill down reporting purposes.
EDI (Electronic Data Interface)
- Sync with EHR
- 837P/I Incoming and Outgoing
- 835 Incoming and Outgoing
- CCR/CCD for Data Exchange with Capable Providers and State HIE
We aren’t successful unless you are. That is why we take our implementation process so seriously. While each implementation is unique, most AlphaMCS implementations consist of the following 7 steps.
- Project Plan
Our Implementation team is guided by a detailed project plan developed in coordination with you and your staff.
- System Survey & Functional Design
We will conduct multiple reviews that focus on assessing the current system functional designs and develop new processes to reach your goals based on the design and setup of AlphaMCS.
- Software and Database Configuration
The optimal software and database configuration is determined by the system survey and system functional design. Mediware will work with you to identify the system configuration that best meets your needs.
- Schedule Training
Training is typically conducted on-site using the train-the-trainer model. Mediware staff are available to shadow your trainers throughout the process. Training materials like manuals, technical documentation and videos will also be provided.
- System Test
To ensure a successful implementation, you have the opportunity to validate and acceptance test the system throughout the implementation process.
- Data Conversion
Mediware will work closely with you and your team to make sure your client, claims, provider, user, authorization and clinical documentation data is transferred to AlphaMCS.
- Go Live
The go live date will be arranged and confirmed based on the finalized project plan. To help ensure a smooth transition, Mediware will provide onsite support for the week of go live.
- Project Plan
Once you’re running, we’re always just a phone call away
We provide a complete set of support services to ensure you’re always getting the most out of AlphaMCS.
Our telephone support is available during normal business hours (8:00am to 5:00pm Monday through Friday EST) for normal technical consultations. However, our team is available 24 hours a day 365 days a year for emergency system down situations.
Customer User Conference
Mediware offers a customer user conference held every year. This provides a great experience to network and see what others in your industry and adjacent industries are doing to be successful.
Continuous Product Updates
AlphaMCS is continuously being updated to provide the best experience for our customers. All regular updates included as part of your subscription agreement.
Enhance Your System
With the optional AlphaMCS Data Warehouse and Business Intelligence Solution
Your ability to analyze data and monitor key performance indicators from a single source of data is the key to success. Since AlphaMCS is built for a high volume of transactions, it is difficult to report on trends or historical information. That is why we developed the AlphaMCS Data Warehouse and BI solution.
The heart of any great BI solution is the ability to slice the data by type of data and timeframe referred to as dimensions. The AlphaMCS BI solution consists of 130+ dimensions that can be utilized individually or in various combinations to allow for millions of possible reporting and analytical options. The BI solution contains 220+ pre-defined measures that can be used for reporting and analytics sliced by the related dimensions.
The BI solution currently contains the following perspectives and will continue to grow based on user feedback: