MCMS handles medical claims processing and reconciliation for hospitals, insurers, and third-party administrators. It tracks each claim from intake through adjudication, payment, and reconciliation, with the documentation discipline required by payers and the workflow controls hospitals need to keep cash flowing.
Overview
Medical claims is a paperwork-intensive process where errors at intake compound into denied claims and delayed payment. MCMS standardizes the claim lifecycle on a single platform, captures supporting documentation at the point of service, and pushes structured data to payers in the formats they accept.
Functional coverage
- 01Claim intake from OPD, IPD, and discharge
- 02Validation against policy coverage, exclusions, and pre-authorization
- 03Document capture for clinical notes, bills, and discharge summaries
- 04Submission to insurers and TPAs in their preferred formats
- 05Tracking of payment, short-payment, and denial responses
- 06Reconciliation against patient accounts and hospital receivables
- 07MIS for denial reasons, turnaround time, and cash position
Key features
- 01Integration with eHMS for seamless intake from clinical records
- 02Role-based access for billing, audit, and finance teams
- 03Configurable rule engine for payer-specific validation
- 04Audit trail across every stage of the claim lifecycle
- 05Exception dashboards for stuck or denied claims
Why MCMS
Hospital cash flow lives or dies on claim discipline. MCMS replaces the spreadsheets and email chains that typically govern this process with a structured workflow, and the tight integration with eHMS means there is no double-entry between the clinical and billing systems.