QCSI Releases QMACS 4.10; New Version Includes Additional Support for HIAA Fee Schedules and APC Pricing.Business Editors/High-Tech Writers
PHOENIX--(BW HealthWire)--May 17, 2001
QCSI QCSI Quality Care Solutions, Inc. (Quality Care Solutions Inc.), provider of enterprise-wide solutions for healthcare payers, Thursday announced the commercial availability of version 4.10 of its award-winning QMACS application.
This rules-based, advanced payer application manages the interactions between all lines of business and a health plan's members, providers, and employer groups.
Health plans using QMACS are substantially increasing the rate of automated claims processing and improving the drop-to-pay ratio on a system that allows health plans to respond quickly to new business opportunities.
The new QMACS release includes a significant number of claims processing enhancements such as the incorporation of an optional APC (1) (American Power Conversion Corporation, West Kingston, RI, www.apcc.com) The leading manufacturer of UPS systems and surge suppressors, founded in 1981 by Rodger Dowdell, Neil Rasmussen and Emanual Landsman, three electronic power engineers who had worked at MIT. OPPS OPPS Outpatient Prospective Payment System (hospital/medical) pricing component to meet HCFA's regulatory requirements, providing health plans the ability to use their existing HIAA HIAA,
n.pr the abbreviation for Health Insurance Association of America. fee schedules, and allowing an increased number of modifiers per claim detail line for a given service, are just a few of the new advancements.
"QCSI clients are able to enhance their ROI (Return On Investment) The monetary benefits derived from having spent money on developing or revising a system. In the IT world, there are more ways to compute ROI than Carter has liver pills (and for those of you who never heard of that expression, it means a lot). even further with the increased performance of mass adjudication The legal process of resolving a dispute. The formal giving or pronouncing of a judgment or decree in a court proceeding; also the judgment or decision given. The entry of a decree by a court in respect to the parties in a case. , batch payment and capitation processing," said Gregory S. Anderson, QCSI president and chief executive officer.
"In response to our growing installed base as well as our prospective clients, we've also increased the value of QMACS by adding nearly 100 functional enhancements."
"A large proportion of the performance increase of QMACS is a result of the additional options available for defining rules that allow for a more automated claims process," said Mikel Echeverria, QCSI executive vice president and chairman.
"For example, health plans can now utilize reciprocating benefit accumulators for outpatient services outpatient services Hospital-based services Managed care Medical and other services provided, to a nonadmitted Pt, by a hospital or other qualified facility–eg, mental health clinic, rural health clinic, mobile X-ray unit, free-standing dialysis unit Examples that can be applied to coordinating inpatient services, allow automatic computation of penalties assessed on late claim payments, and determine co-payments and deductibles per employer requirements or state mandates."
QMACS now provides enhanced search features for members, providers and employers, and allows mandatory benefit riders to be automatically selected for members at the time of enrollment.
With QMACS, health plans can add a handicapped accessibility attribute to a provider's demographics in compliance with HCFA HCFA
Health Care Financing Administration
n.pr See Health Care Financing Administration. and the American Disabilities Act (ADA Ada, city, United States
Ada (ā`ə), city (1990 pop. 15,820), seat of Pontotoc co., S central Okla.; inc. 1904. It is a large cattle market and the center of a rich oil and ranch area. ) and assign Standard Industry Codes (SIC) to an employer group for underwriting and actuarial purposes.
User-defined role-based security was enhanced in QMACS, as well, to create a more flexible prior authorization prior authorization,
n See predetermination.
prior authorization Health insurance A cost containment measure that provides full payment of health benefits only if the hospitalization or medical treatment has been and referral process. Health plans are now provided a means to more easily manage authorizations and establish the level of medical personnel authorized to approve procedures requiring prior authorization.
QCSI (Quality Care Solutions Inc.) develops award-winning healthcare administration solutions enabling healthcare organizations to conduct real time claims processing and adjudication to streamline their business processes with advanced reporting capabilities.
QCSI solutions reduce training and education costs with an intuitive user interface and modular application design.
The proven scalability and flexibility of QCSI products and services allow payers to quickly respond to new business opportunities. QCSI is a privately held, high-growth company headquartered in Phoenix. For more information, call 480/735-7000, email firstname.lastname@example.org, or visit www.qcsi.com.
QCSI and QMACS are trademarks or service marks of QCSI. Patent Pending. Other product and company names herein may be the trademarks of their respective owners.