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Healthcare is a tricky industry that revolves around multiple providers, services, and regulations. And particularly for care management organizations (CMOs), maintaining a fluid workflow between different parties is a must. However, contracting providers, configuring benefit plans, and processing huge amounts of data can be challenging. In fact, an article about healthcare challenges in 2017 notes how organizations face problems regarding data security, ICD codes, and even telemedicine. And with the growing demands of the industry, organizations might need to recheck their current management software. That is, if you want to stay competitive for the next few years.
Processes like provider contracting, electronic data interchange (EDI), and claims adjudication are just a few of the many responsibilities of MCOs. But with the right management software, organizations generally keep up with the workload. However, problems occur when technological advancements demand newer processes from MCOs. For example, the leap from ICD-9 codes to the newer ICD-10 codes caused a lot of system problems for companies. And organizations with systems that couldn't adapt as fast have to rely on other software to keep up with demands. Which leads to spending more dollars on third-party systems.
Keeping up with industry demands also means that your data security is on point. In fact, having secure management software is necessary to keep up with HIPAA standards. Additionally, the advancement of mobile applications are also allowing patients and providers to access healthcare data via smartphones. Which means that MCOs need advanced management software that offer advanced tools like apps or the flexibility to integrate newer technologies. With all this in mind, how do you pick the best care management software?
You don’t just need care management software, you need one that has all the tools to keep up with modern demands. In fact, you want a system that has the technology to stay competitive for decades. Luckily, MCOs can now upgrade to more advanced management software like QuickCap 7. In fact, here are a couple of key features to look out for:
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CORE Certification Achievement
MedVision has achieved CORE Certification in accordance with the CAQH CORE Operating Rules for Eligibility & Benefits, Claim Status, and Payment & Remittance. This certification validates that MedVision’s systems adhere to nationally recognized standards for interoperability and automation in healthcare transactions.
CORE certification reflects MedVision’s commitment to improving healthcare administration, increasing efficiency, and ensuring reliable data exchange across the industry. By complying with these rigorous standards, MedVision strengthens trust with clients, partners, and payers, while upholding excellence in healthcare IT operations.
SOC Certification Achievement
MedVision has successfully met the criteria outlined in the SOC (System and Organization Controls) audit for service organizations. This certification demonstrates MedVision’s adherence to rigorous standards for security, availability, processing integrity, confidentiality, and privacy.
As a service provider managing sensitive data and overseeing critical functions on behalf of clients, this certification underscores MedVision’s commitment to maintaining high standards of operational excellence and data security.
HITRUST Risk-Based 2-Year Certification Achiever
The Health Information Trust (HITRUST) is a standards organization dedicated to security, privacy, and risk management. They developed the HITRUST Common Security Framework (CSF), which assists organizations in maintaining a comprehensive and secure approach to HIPAA compliance and managing risks. HITRUST is widely recognized as the benchmark in data security and privacy.
Certified Member of HCAA
The Health Care Administrators Association is the nation's largest nonprofit trade association for third-party administrators, stop loss insurance carriers, managing general underwriters, audit firms, medical managers, technology organizations, pharmacy benefit managers, brokers/agents, human resource managers, and health care consultants. HCAA has spearheaded the change of self-funding for more than 35 years.
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