Implementing Eligibility, Reporting, Authorization, Certification and other Functions

Establishing eligibility, reporting and guideline implementation are essential components of the health plan administrative process. Prior authorization for diagnostic and therapeutic procedures is among the most commonly used methods for cost containment by health care entities at financial risk. The implementation of these administrative functions is largely inefficient and adds considerably to administrative costs due to added clerical and clinical personnel.

For maximum cost savings for health plans MatheMEDics offers a web-based configuration of its decision support software. This software resides on MatheMEDics' web sites on multiple servers, and are completely maintained by MatheMEDics. Logging on to server is protected by passwords. Security and speed would be powerfully enhanced by using Tier I Internet providers with dedicated machines connected directly to the Internet backbone through a high bandwidth (T-3) line.

The web-based system is set up with the software residing on the MatheMEDics web site and is accessible through a standard browser. The same software may be used by different health plans, or each plan may elect to have its own custom software version. If a physician wants to process any type of request he logs on to the Internet using a standard PC with Internet connection. He proceeds to the MatheMEDics web site and accesses the software in web page form by entering his username and password.

Each day a health plan system administrator downloads the authorization data from MatheMEDic's web site. This file can then be integrated with the plan's own billing and patient administration software. We can develop software to automate this integration process.

This setup has several advantages:

• Easy setup at doctor's office: The majority of physicians already have a standard internet connection. This is the only requirement to access the system.
   
• No maintenance: The web site and all software is maintained by MatheMEDics and we ensure that the sofware runs reliably at all times. The health plan has absolutely no maintenance responsibilities.
   
• Improved speed: Patients and doctors will appreciate this system with instant response to requests instead of a waiting period. Physicians will be able to establish eligibility and schedule their patients' referrals, hospitalizations, or studies at the time of their visit without the need for waiting or the irritation of botched or delayed notification. A reduction in this "hassle factor" adds considerably to the attractiveness of our system for all concerned-patients, physicians, and health plan.
   
• Easy software updates: When the health plans adopts our software package, we can expeditiously customize, install, and implement the software for them. Because the software runs at one central point (our web site), an update is far easier than updating client server software running on an in-house or physician network on dozens or hundreds of PC's. The savings on upgrades and maintenance for any Internet-based browser accessible software are enormous when one considers the administrative costs of a large IT (information technology) staff.
   
• Cost saving: Significant cost savings will result from improved speed and efficiency. Over 90% of requests will be handled by the fully automatated system. This will dramatically decrease paperwork, filing, and the need for faxing, phoning, and data entry by authorization clerks. Moreover physician reviews will be significantly reduced as well as patient and provider appeals.