DESCRIPTION OF SERVICES
Meridian Health Care Management, Inc. ("MHCM") is one of the Nation's most experienced companies providing administrative infrastructure outsourcing solutions to Managed Care Organizations ("MCOs"). Our mission is to provide and/or support the efficient processing of complex sets of managed care administrative and payment transactions, facilitate electronic communication and transaction processing among and between health care providers and payors, and provide managed care network management and consulting expertise. MCOs consist of health care provider organizations (e.g., IPAs, PHOs, MSOs) as well as payors of health care benefits (e.g., health plans, self-insured employers).
Health Benefits Transaction Processing
Transaction processing is provided in the areas of payor eligibility verification, medical management referral and case management processing, and claims adjudication and payment.
MHCM utilizes its internally developed product ("WebIPIX") to provide an Internet-based front-end user application to physician offices. This application electronically links each provider to MHCM's integrated information system allowing Internet access to patient eligibility and provider claims information, and processing of referral and authorization transactions.
Network Management and Consulting
MHCM provides a complementary set of provider network management and consulting services including: provider contracting, provider relations, data and information profiling and reporting, financial analysis and reporting, executive management, operations assessment, and high-level strategic planning.
MHCM provides its Information Technology on an ASP ("Application Service Provider") basis as a remotely-hosted fully integrated systems solution to process membership, capitation, benefits, referral authorizations, claims payment, stop loss, etc. The ASP approach is enormously more cost-effective than traditional information technology vendor relationships.