Reimbursement Capabilities


The software has the capability to accommodate any number of networks, hundreds of thousands of providers and millions of rates and reimbursement records, including:

  • DRGs
  • Per-Diems
  • Global Rates
  • Fee For Service
  • Percentage Discounts
  • Minimum Maximum Charges
  • Minimum Maximum Discounts
  • Ambulatory Surgical Groupings
  • Modifier Rules (Medicare Guidelines or Fee Specific)
  • Anesthesiology, Physical Status and Qualifying Circumstances

The MCO Pro software also provides many automatic services as well as the ability to apply rates and fees based on a specific product or network:

  • Automatically Identify Duplicate Services
  • Apply Rates Based on Product and/or Network
  • Assign Carve Out Rates and Fees to a Single Provider
  • Automatically apply the Appropriate Rate or Fee to any claim
  • Assign Multiple Rates and Fee Schedules to a Single Provider over time