AllPayor® Software

 

AllPayor® Software

Robust. Rock-Solid. User Friendly.

MCAs AllPayor® is the most robust and user-friendly contract modeling and claim management software solution in the world. Our AllPayor® software pre-calculates the expected plan benefit and compares that amount to the payment processed by the payor. Over the years our systems have identified tens of millions of dollars in unpaid and underpaid claims to hospitals all over the country. AllPayor® also plays a crucial role in the shifting landscape of Healthcare Pricing Transparency. Here's why implementing our AllPayor® contract modeling software and claim management software will be a game changer for your hospital.

Our design goals were simple.


Begin by creating a system that is functionally rock-solid, fast, accurate, technologically advanced and easy to use. Then make it accessible through the web with no user capital outlay. For users, make it intuitive, totally point and click. Build it in Oracle - the best database in the world - and keep it locked-down HIPAA secure. Ensure contract modeling capabilities for any payor contract around - United, Aetna, Blue Cross, Humana, CIGNA, Medicare, Medicaid or any other payor. Then make it available to all hospitals for a reasonable, all-inclusive monthly fee. The final result is simply the best, most well designed, robust, user-friendly contract management and claim modeling software available today...period. And, the smarts you need to manage your contracts and patient claims.

Data Protection is our highest priority.


AnalyTXs AllPayor® is web-based. This ASP model system allows desktop access by every client designated hospital employee. Access privileges are employee specific, controlled by the client and are easily modified. Data Acquisition is simply designed to be a by-product of routine hospital operations and does not require the use of valuable hospital Information System resources. Most of all, rock-solid reliability and top-level security for your claim management & contract modeling needs.

Millions of dollars recovered


The AllPayor® system is MC AnalyTXs' rock-solid, proprietary driving force for recovering millions of dollars in underpaid claims.
 

Use the AnalyTXs AllPayor® Claim Management & Contract Modeling Software to:

1. Calculate The Plan Benefit


What is The Plan Benefit?


The Plan Benefit is the total amount payable under the terms of the agreement with the payor. It includes amounts that are to be paid by the payor, as well as amounts that are to be paid by the patient, such as deductibles and co-insurance.

The AnalyTXs AllPayor® system employs a unique toolbox which allows all contract terms to be modeled and the Plan Benefit to be calculated.
For example: carve-outs based on diagnosis codes and/or procedure codes with ceiling limits or limits based on per-unit values are easily accommodated. Some of the tools in the toolbox are stop-loss, rehabilitation, skilled nursing, newborns, neonatal, laparoscopic procedures, CT scans, MRIs, trauma team activation, open heart, high-cost drugs, implants, outpatient fee schedules, ASC tables, etc. New tools are easily created and deployed in a matter of hours for any of the unique contract terms which might not fit into already established tools. The sum of the calculated amounts due under the specific terms of the contract is the Plan Benefit.

Plan Benefit expected from all Payors and compare that expected benefit to the actual payment(s) received. Identify all

 
 

2. Create Instant


What are Models?


AnalyTXs AllPayor® applies user-specified contract terms to whatever population of hospital claims you select and creates a model population that can be evaluated using the systems reporting tools including drill down to claim level detail.

+ Negotiate payor contracts Know the bottom-line financial impact of contract provisions
+ Have the facts you need Evaluate and quantify by product line, facility, physician more
+ Develop alternate strategies Plan your negotiating campaign step-by-step

The AnalyTXs AllPayor® system easily permits existing contracts to be cloned; similar contracts can be quickly set-up with only minor changes to specific rates and percentage factors. A proposal received in the morning can be modeled and evaluated that same day. Compare the proposed contract terms to any population of your claims you wish. Pick any population of claims that you feel mirrors the case mix of the proposal and see how it stacks up with Blue Cross, or Aetna or United or even Medicare or Medicaid. Reporting advances make it easy to quantify the real-time effect of specific contract term changes by Product Line, Facility, or even by Physician or Physician group.

And you don't need to be a programmer to use the AnalyTXs AllPayor Modeling feature.
Test drive the payors proposed contract terms and identify all the counter proposals your hospital can live with.
Models using "what-if" clones of your existing contracts applied directly to your claim data. Instantly evaluate contract proposals against your unique case mix. Quantify the effect of counter-offers real-time during the negotiating session. Negotiate the best payor contract terms.

 
 

3. Confidently record your monthly


What is the Contractual Allowance?/h4>

The Contractual Allowance is the difference between Covered Charges and the Plan Benefit. Changes in the hospital's charge structure, utilization patterns, and payor mix can cause significant fluctuations in this difference.


The AnalyTXs AllPayor® system calculates a contractual allowance for each filed claim. Adjustment claims (late charges, series claims, replacement claims, etc.) are consolidated in accordance with plan specific consolidation rules and the contractual allowance is automatically recalculated to reflect these adjusted charges and the revised plan benefit. At period-end, the AnalyTXs AllPayor® system will contain the most up-to-date contractual allowance possible for the entire filed claim population.

Your hospital will also have an inventory of un-filed and in-house charges. These unfiled charges are grouped into the AnalyTXs AllPayor® system by payor. Then a user-defined range (by discharge date) of the filed claim population is used to precisely estimate the contractual allowance for these period-end charges. This process is marked to remain open while the hospital is working on the Period-end financials. When the accounting period is closed, this process is marked closed.
Once marked closed it cannot be changed. This precision provides auditable evidence the hospital has diligently established, monitored, evaluated, and verified the accuracy of this most important portion of their internal financial process consistent with the intent of the Sarbanes-Oxley Act.

Contractual Allowance for unbilled and in-house charges. This unique function eliminates spreadsheets, ties directly to your filed claim population, and creates a formal structure. Exceed Sarbanes-Oxley standards.
 
 

4. Compare


Defining Profitability


The Plan Benefit represents the real or disposable yield from the services provided to each patient. Covered charges represent the resources applied in providing those patient services.

The AnalyTXs AllPayor® system is extremely flexible, facilitating profitability analysis by individual facility, groups of facilities or totals for all facilities. Profitability can be reported first by facility and then broken down by inpatient, by outpatient, by discharge date range, by admit date range, by filed date range, by payor contract, by hospital defined product line, by physician, by major disease category, by responsible billing clerk (data elements include patient number, patient name, HIC number, medical record number, contract benefit, settlement amount, payment difference, physician, and many more then drill down to the individual detail claim level).

The possibilities are endless and allow senior managers to identify and seize strategic initiatives. Put valuable capital budget dollars into breakaway product lines and retool stagnant centers of excellence before they become inoperable.

Profitability by Payor, by Facility, by Product Line, by Physician … the possibilities are endless. From any report, drill down to the individual claim level detail. Identify and capitalize on your competitive strengths - eliminate competitive weaknesses.
 
 

5. Create


Pricing Transparency


Patients today want and expect to have pricing information when shopping for elective healthcare services. The AnalyTXs AllPayor System® uses your hospital-specific claim, payment, and payor contract information to compute an estimated out of pocket amount so you can provide advance and accurate procedure specific quotes for your patients.

Each hospital has a unique pricing structure which is a product of their operating costs, capital structure, teaching mission and their medical staff’s practice patterns and training, along with the hospital’s mission, unique state mandated standards of care, contract negotiating clout, nurse staffing levels, and too many other factors to list here.

Each patient seeking care has a unique health status reflecting factors such as age, overall physical condition and may have complications such as diabetes, high blood pressure or heart disease. The patient has also selected or been provided their particular insurance coverage which can have various deductible and co-insurance requirements as well as the physician they have chosen to render care.

The AnalyTXs AllPayor System® System uses all of the hospital's specific claim data, payment data and negotiated payor contract terms, operating through MCAs ASP Oracle database, to instantly abstract that data and produce a visit specific price quote.

Patient Pricing Quotes in response to patient inquiries...using your hospital's specific claim, payment, and contract data. Produce a procedure specific quote which includes all of your usual and customary charges for such visits. Tell the patient in less than a minute what the out-of-pocket liability will be and collect the deposit on admission.