Modern flexible solutions for your clients health plan needs
WHERE TO BEGIN
MCA can provide you and your client with an in-depth analysis of their current medical benefit offering. If your client is currently self funded MCA can show how to improve their plan performance, cut costs and gain greater control over employee medical expenses by:
creating financial risk/reward models that let you recapture plan savings year to year
eliminating inflated carrier profits from their costs
reducing health risks across the population with dynamic population health strategies
keeping your client in control of their plan designs
only taking on the level of risk that is appropriate for your client (reinsurance management)
BUILDING PLANS THAT ARE RIGHT FOR YOU
At the core of all medical benefit coverage is the blueprint or Plan Design. MCA uses the industry’s most sophisticated modeling tools to help design and build comprehensive and cost effective plan designs for your company and this critical process, the foundation for all medical benefit activities, will dramatically affect both a plan’s short term and long term performance. Medical benefit offerings can be industry specific, geographically influenced or economically driven. MCA can help your company tailor a plan that will precisely fit your business’s needs.
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MEDICAL CLAIMS ADMINISTRATION
MCA combines 40 years of professional claim adjudication expertise with state of the art information technology to ensure benefit claims are timely and accurately paid.
RISK MANAGEMENT/STOP LOSS ADMINISTRATION
Corporate fiduciary responsibility demands that risk be minimized, so MCA works directly with the top reinsurance carriers in the industry to provide our clients with stop-loss coverage at competitive rates.
CLAIM COST CONTAINMENT
MCA has systems to contain costs and improve quality and outcome by identifying high-risk conditions before they escalate into catastrophic illnesses. Furthermore, our system works to spot inaccurately billed claims and helps negotiate costs of care.
FLEXIBLE SPENDING HRA/HSA ADMINISTRATION
MCA is fully equipped to manage diverse plan types including Health Savings Accounts, Health Reimbursement Accounts and Flexible Spending Accounts. These services are available independently or can be integrated through MCA medical benefit administration.
DENTAL/VISION CLAIMS ADMINISTRATION
MCA offers single source administration by providing ancillary benefit management including dental and vision claim adjudication and payment.
MCA offers administrative solutions for COBRA and HIPAA needs. MCA regulatory compliance services help ensure compliance with HITECH, ERISA, FMLA, TEFRA, and DEFRA.
MEMBER SUPPORT SERVICES
MCA member services division is available to assist members with their everyday questions and needs. Members can obtain information via a dedicated MCA member support representative or electronically through our secure web site.
BENEFIT PLAN DESIGN AND ENGINEERING
MCA custom designs benefit plans for companies based upon the unique history and demographics of their employee population. MCA can help you tailor a benefit plan that protects your corporate fiduciary responsibility while improving the health of your employees.
MCA works with professional care management partners (DM/CM/Precert/Wellness) to help manage the cost of the chronically ill and other high-risk populations. The techniques utilized help prevent condition escalation while improve member wellness and controlling costs.
STUDENT HEALTH PLAN ADMINISTRATION
MCA provides guidance and comprehensive plan services to help you meet the administrative needs of a Student Health Plan. MCA services are designed to provide an affordable turnkey solution from enrollment to claims adjudication.
ENHANCED PLAN REPORTING & ANALYSIS
MCA puts every aspect of plan operation and financial accounting at the employer's fingertips through real time comprehensive analytical reports. MCA reporting helps plan decision makers measure performance and proactively make changes.
PBM & PRESCRIPTION FORMULARY DESIGN
MCA works with multiple nationally recognized Pharmacy Benefit Management companies to match employers with an appropriate Rx benefit partner. MCA works hand in hand with employers to engineer a prescription drug formulary that enhances plan savings and increases responsible utilization.
MCA works hand-in-hand with networks nationwide to provide the greatest options for member access to quality affordable care.
EMPLOYEE ASSISTANCE PROGRAMS
MCA can assist in building an effective EAP utilizing specialized behavioral health programs including inpatient and outpatient drug treatment programs.
SHORT TERM DISABILITY ADMINISTRATION
MCA provides comprehensive Short Term Disability claim administration services to help ensure FMLA/STD benefits are properly coordinated. MCA uses expert claim assessment, adjudication and management techniques to efficiently and effectively process Short Term Disability claims.
CARE Network Services
PRE-CERTIFICATION/CONCURRENT REVIEW/DISCHARGE PLANNING
Acute Inpatient Medical/Surgical Hospitalizations
Acute Inpatient Rehabilitation
Long Term Acute Care (LTAC)
Acute Inpatient Psychiatric/Mental Health Treatment
Acute Inpatient Chemical Dependency Treatment
Case Management of the Clinically Complex Patient is comprised of:
Cohesion of Care
Patient/Family Education, Guidance and Support
Accessibility of Alternate Care
Conservation of Health Care Dollars
OUTPATIENT UTILIZATION REVIEW
Elective Outpatient Same Day Surgeries (performed outside of a physician's office)
Elective Diagnostic Procedures (performed outside of a physician's office)
Outpatient Continuing Services (physical/occupational/speech therapy, home health care, etc.)
Outpatient Psychiatric/Mental Health/Chemical Dependency Services
MATERNAL NEWBORN PROGRAM
Detection and Management of Potential High-Risk Pregnancies
Early Maternal Intervention
Coordination of Services
POINT OF SERVICE PROGRAM HEALTH MANAGEMENT
Specialist Referral Management
Primary Care Physician/Gatekeeper Support
WELLNESS HOPE HEALTH NEWSLETTER
Monthly Health and Wellness Newsletter
Prevention/First Aid/Health Topics
Benefit Planners & Associates Services
SELF-FUNDING GROUP HEALTH CONSULTATION
Large group health plans have much to gain from Benefit Planners and Associates experience designing, implementing and managing partially or fully self-insured healthcare plans. Benefit Planners and Associates works hand-in-hand with MCA to ensure employers realize the maximum value of self-funded benefits.
FULLY INSURED CARRIER QUOTES
Benefit Planners and Associates works with major insurance carriers to provide competitive quotes in order to maximize coverage while keeping costs down.
ANCILLARY GROUP BENEFITS
Benefit Planners offers a single source solution to employer groups by providing a variety of ancillary benefit products including:
Long Term Disability Short Term Disability
Long Term Care Coverage
Benefit Planners and Associates works with only the most trusted reinsurance carriers to ensure employers maintain the appropriate levels of risk for their self-funded group health plans. Competitively priced aggregate and specific excess loss coverage is arranged by Benefit Planners and Associates to cap spending and protect the fiduciary check book.
BENEFIT PLAN ENGINEERING AND PLAN MANAGEMENT
Benefit Planners and Associates helps employers manage the duties of administration through an ongoing review of plan performance that includes recommendations for opportunities to improve plan efficiency. Benefit Planners helps maintain the advantages of self-funding by providing continuous oversight of plan performance and monitoring changes in regulatory requirements, allowing us to engineer benefit models that maximize plan performance.