MCRA Members
Growing a business in today's siloed health plan environment is very challenging. MCRA can be a valuable resource for outreach and growth initiatives. MCRA builds partnerships among Members of the Alliance. Active participation and willingness to support other Members facilitates strong relationships and new opportunities.
DRG Claims Management
Regulatory End-to-End Encounter Reporting for Health Plans
DRG Claims Management (DCM) has been offering cost containment solutions to health plans across the United States since 2013.
WHY DRG CLAIMS MANAGEMENT?
They differentiate from their competitors with customizable solutions and customer service.
REGIONS SERVED:
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New Jersey
MANAGED CARE SEGMENTS / LINES OF BUSINESS SERVED:
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MCO
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Commercial
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Self funded
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TPA
PRODUCTS / SERVICES:
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Inpatient DRG Audits (MS & APR)
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Cost Outliers
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Readmissions
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Short-Stay/OBS
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Skilled Nursing Facility (PDPM/RUGs) audits
Their models include: Post-payment Model: Focuses on addressing inaccurate coding and clinical errors retrospectively, maintaining good relationships with providers, and ensuring a smooth refund request process. Prepayment Model: Preferred by health plans to prevent overpayments, reduce turnaround time, increase provider response, and ensure the audit of out-of-network claims. DCM has a unique approach to DRG and SNF management that easily plug into a 2nd or 3rd pass – we find dollars behind other vendors. Our AI-powered and industry-expert approach allows us to offer:
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$20 PMPM Savings: Strategic impact on cost reduction.
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40% Audit Hit Rate: Nearly one-third of all records audited lead to actionable insights.
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96% Medical Records Acquisition: They effectively obtain the necessary documentation.
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95% Accuracy Rate: Precision underlines every audit decision they make.
