MedMetro Extranet is web-based, HIPAA
compliant application that enables secure data transactions
to and from network providers. Features include:
Eligibility Look-Up
Providers may view a member’s
eligibility, co-pays, and Primary Care Physician (PCP)
assignment.
E-Lists are available in a report format, enabling users
to sort, analyze and perform capitation
reconciliation.
Authorization
Allows network providers access to
the network, based upon assigned permissions, to submit
and look up authorization requests. Requests for services
are then submitted through a streamlined
interface and may receive an automatic approval based
upon predefined, customized business rules.
Claims
Look-up, submit, and appeal are the
primary features of this tool. Single or batch submission
of
encounters and claims allow for an instant, user-friendly
and HIPAA compliant submission to the
Managed Care Organization. Validations, designed in accordance
with the client’s business rules,
are performed at the point of submission. Corrective feedback
is then generated back to the submitting
provider, thereby reducing the number of rejected records.
Provider Look-Up
View a roster of all participating
providers. Information that may be included in the roster
is languages,
demographics and hospital privileges. This tool enables
providers' periodic review of data and the
ability to submit updated information requests via the
Contact Us feature.
Forms and Docs
A bulletin board which may be utilized
by the Managed Care Organization to post reference forms,
provider manuals, and newsletters. In addition, Capitation
or Fee-For-Service EOB’s may be posted
for providers' viewing.
Contact Us
A communication tool between the network
providers and any department in the Managed Care
Organization. An E-mail message is then generated and
sent to a designated representative,
substantially reducing the number of calls into the MCO.
MedMetro Extranet offers all network
providers and hospitals the ability to efficiently
manage repetitive time-consuming processes via the Internet.
