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Contents Client Comments (3) Overview (4) AllPayor System Benefits (5) Calculate the Plan Benefit (6) Collect Pay Differences (7) Record the Contractual Allowance (8) Model Contract Proposals (9) Software Specifications (10) Unique Features (11 & 12)

Client Comments “MHP issued SSM a settlement check for $408,000 on 06/03/09.  This is the first part of an

ongoing process, there are additional settlement amounts in the future. (SSM)

“Ken, just to let you know, we picked up an additional 8% on our contract negotiation! Thanks for your help modeling their initial proposal. (UMISS)

“I've been comparing PCON to MCA and to make a long story short, the vast majority of errors appear to be in PCON. For example, all of the CT scans in PCON are calculating incorrectly (since August). Another big chunk of PCON errors are due to rates that were not updated. Another chunk are due to an outdated PCON radiology fee schedule. And so on. (SSM)

“FYI, during the set-up of the new MCA tool, MCA identified 20 Medicare inpatient accounts as under paid due to an error at Medicare.  We initiated the appeal process with Medicare and just received an additional $192,000 for these accounts!!!  Just during the install!!! (HCHD)

“The staff at MCAnalyTXs are wonderful, they support you every step of the way. The system is very user friendly and everything is at your fingertips. The system has already identified several underpayment opportunities for us.” (Nix)

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OverviewThe AnalyTXs AllPayor System is designed to solve four major hospital problemsCalculate the plan benefit expected from all Payors and compare that expected benefit to the actual payment received. Then collect system identified underpayments.Create instant models using "what-if" clones of existing contracts and apply them directly to hospital claim data. Instantly evaluate contract proposals for your unique case mix.Create price quotes that create a prototypical “bill” from hospital’s data, priced at their negotiated contract terms for any payor and that reflect the patient’s net “out-of-pocket” cost of the service.Record the period-end contractual allowance for unbilled and in-house charges (exceed Sarbanes-Oxley standards).

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AllPayor System Benefits Make sure all claims are paid in accord with the contract –

collect underpayments before deadlines pass. Identify internal billing and record keeping issues that

cause claim underpayments/denials – improve cash flow. Book a period-end contractual that is developed in a

logical, auditable and consistent manner – avoid financial disaster.

Negotiate rates from a position of strength. Evaluate the overall net affect of the proposed blend of rates, weights and factors – know the bottom line before signing the deal.

Analyze net benefit by facility, by plan, by strategic business unit, even by Physician. Sift out opportunities and act before the rest of your community – be pro-active.

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Calculate the Plan Benefit Easy Plan Term Set-up

Either MCA’s staff or the hospital’s staff may set-up the contracts (no special off-site training) – the hospital’s option.

Point and click contract terms “tool box” and plan cloning make loading plans fast and easy.

Easy Data Acquisition MCA accepts all 837 or print image UB-04’s from the

hospital’s claim editor each day – day forward and/or retrospectively as well as 835 payment data and/or print image daily payment posting data.

MCA accepts claim and payment data “as is” so vital hospital Information Systems resources are not burdened.

As plans are set up, claims are flagged to pass from a hold file into the AnalyTXs AllPayor System automatically – unflagged claims are held forever and move in as flagged – a real advantage for new or modified plans.

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Collect Pay Differences Easy Payment Difference Identification

Real-time payment difference reporting – reports high to low differences – by plan, by facility, by biller, etc.

Click on any difference – drill down to the detail claim level. Easy Payment Difference Adjudication

From a drop-down menu at the claim level select any adjudication letter – infinite letter possibilities.

Click on any letter and it immediately contains all of the patient specific information – amounts due – authorization codes, payor mailing address etc.

Write a note or click a “park code” to flag the claim for later review, mail the adjudication letter and you are done.

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Record Contractual Allowance Contractual Allowance For Filed Claims

As each claim is filed, the AnalyTXs AllPayor System automatically computes the plan specific write-off.

Multiple claims, late charge claims, replacement claims, DRG and Payor changes are automatically consolidated and adjusted according to plan specific rules. Write-off amounts are being updated by daily claim filing.

Contractual Allowance For Unfiled Claims Easily populate the AnalyTXs AllPayor System with the period-

end inventory of in-process claims. System uses dynamically self-adjusting filed claim write-offs by

Payor to calculate the period-end GL adjustment. Click option to permanently lock the period as proof against

subsequent number tampering – Sarbanes-Oxley sound.

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Model Contract Proposals Model Contracts the Day They are Received

Clone a similar plan – takes less than a minute. Click the toolbox to add or delete plan provisions. Enter the newly proposed dollar amounts or percents in the

tables invoked by the tool box. Select as a base for the model any existing plan that mirrors

the utilization patterns of the proposal.• Use same plan if you are modeling rate updates.• Use any plan to contrast the effect of new contract terms

applied to its utilization patterns. Run reports to see the net gain or loss from the complex

interaction of the proposed terms. Adjust and repeat as necessary – develop counterproposal

strategies – You can even gage the value of a counter offer while meeting with the payor representative.

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Software Specifications Oracle Application Server 10g provides an optimized ASP

Web platform. Service access is delivered through enterprise portals and mobile devices for real-time business intelligence.

Oracle Forms and Reports provide unrivaled scalability and security.

Claim and Payment data enter the system through a client specific, password protected, 128 bit encrypted VPN tunnel to an FTP site behind a firewall.

Each individual user has application level hospital defined privileges, and unique usernames and passwords that reset at client specified intervals.

Can be used by one or hundreds of hospital employees at no extra charge per terminal. Can be accessed from home or while on the road.

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Unique Features Drill down query by revenue code, HCPCS code, DRG,

diagnosis and procedure code. No special analyst or programmer required.

Model within the system against actual claim data. No need to create extracts or downloads. Done in minutes.

Rapidly compare rates among payors to identify winning contract provisions. A quick comparison of contracts by product line can clarify negotiation strategy.

Set up and use park codes to temporarily or permanently set aside claims or groups of claims. Manage projects easily.

Data is on-line forever. Nothing is striped or archived so every claim and every payment is available as long as you are a client.

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Unique Features - Continued Electronic contract image stored on-line. Users can manually override system generated stop loss,

and add implant, prosthetic and high drug invoice amounts if necessary.

Full claim history on-line. See (and print) the entire UB-92 for the initial claim and all subsequent claims (late charges, replacement claims etc.)

Complete payment history on-line for every claim for primary and secondary payments. Click on each payment and drill down to the remit.

Remote storage of claim data in our functional database is like having an active backup in the event of a disaster.

No per-contract set-up or maintenance charge. 1 or 1,000 contracts, the monthly price is the same.