Managed Care Organization EHR Software

Benefits of SmartCare™ for your MCO (Managed Care Organization)

SmartCare™ MCO is designed to help Managed Care Organizations manage, communicate, collaborate with, and pay their external service providers. This managed care organization software goes beyond just tracking and coordinating services among providers and enables organizations to provide a more holistic collective care plan.

• Easily manage providers, including contracts and rates, credentialing, site review, and provider search for member referrals.
• Process claims from the provider network, including receiving 837 electronic claims; adjudication processing; and payment, check processing, and RA, and 835 distribution.
• Easily manage client information, including current medical and billing status, an overview of all claims by current status, and scheduled events (hospitalizations, discharges, etc.) 
• Track and report on key metrics, including authorization tracking, hospitalization pre-screens, hospitalization concurrent reviews, and hospitalization discharges.
• Manage capitated arrangements, including documentation of UM review of authorizations, justification for approved services that meet URAC standards, and alerts and messages for important events such as when a provider’s contract reaches its cap.
• Provide treatment based on evidence-based principles through performance measurements and standards of care.
• Manage patient population levels of care and create recommended service packages based on patient level of care.