Behavioral Care Management

The issue: The cost of behavioral healthcare services is on the rise but so is the demand. The funds to pay for these services, however, are limited and have been on a decline. Employers - both in the public and private sectors - the offices of Medicaid and Medicare and other such funding sources are demanding the industry be more responsible in managing the cost of delivering these services. Consumers are more sophisticated than ever – the internet has provided them a mean to understanding their issues better. Their needs are changing and access to high quality behavioral healthcare services on-demand is growing.

The solution: The industry needs a solution that allows behavioral healthcare payor organizations to manage the limited dollars available without compromising the quality or integrity of care delivered. Introducing eCura BCM by InfoMC, the only proven BCM solution for managed behavioral healthcare, health plans and public sector payors – MBHOs. eCura allows MBHOs to load eligibility and enroll members electronically, manage your provider network, maintain client contracts and manage benefit plans, allows your care coordinators to generate authorizations and manage utilization, process paper and electronic claims, and use business rules to auto adjudicate claims and payments to providers. eCura also allows MBHOs to process HIPAA transactions and stay compliant with its regulations relating to using standard code sets and privacy and security.

eCura Works the Way MBHOs Work

eCura supports extensive configurations and customization, so it can work the way you run your business. eCura retrieves members’ demographic history and eligibility information through powerful search and tracking capabilities. You have easy access to information that’s complete and accurate—including benefits limits, services available for pre-authorization, and paid claims data.

eCura’s resilient database rises to the challenge of your dynamic requirements. “Point & click” technology with drop down menus and online help allows fast integration of eCura into your organization. It has the ingenuity to streamline your workflow while providing the flexibility to support your unique procedures.

Most importantly for MBHOs, the functional depth of eCura is adaptable and scalable. It helps you anticipate and adjust to procedural changes, ensuring seamless interaction with your providers and ongoing management of your members. So when member data requirements change and new treatment methodologies or modalities are introduced, or referrals need to be monitored or modified, you can respond successfully.

eCura BCM offers you the ability to:

• Link clinical service authorization to claims payment
• Conduct effective utilization management
• Coordinate cases throughout all the levels of care provided by your network
• Meet internal and external reporting requirements
• Exchange information between providers online in real-time via the internet
• and much more

The scalable, customizable eCura is the one solution that can help you defy obsolescence—supporting you every step of the way, through the ongoing changes in managed behavioral healthcare.

All of this within a single integrated, comprehensive, user-friendly solution - eCura BCM, it’s the right solution for the people who put their trust in you.

When properly implemented, configured, and administered, the eCura BCM solution can help you stay in compliance with constantly changing state and federal regulations. Plus, eCura helps you manage and adjudicate claims with three electronic methods:

• A simplified, Internet-based entry tool for your providers to submit data – anywhere, anytime
• Batch capabilities to upload electronic claims data files – HIPAA 835 (i & p)
• Efficient screens for entry of paper claims forms into the eCura database

With eCura, it all comes down to reducing administrative costs while helping you deliver better services to your members.

Extending the power of eCura

eCura is your gateway to becoming an e-commerce business. By connecting your provider network and members to you via the internet, you have more time to manage your business and minimize the frustrations associated with call wait times. eCura allows your providers to check for eligibility, request authorizations, submit claims, check claims and authorization statuses, and a host of other transactions that replace the traditional communications methods including phone, fax, and postal mail. Members can check a span of rich content relating to health and wellness information and score on several self-help assessment instruments all on-line.

• Captures and maintains all types of member information, including optional data elements such as special religious or language requirements
• Provides a secure platform to maintain and update records
• Includes comprehensive searching capabilities to find members
• Helps keep members’ insurance information up-to-date
• Handles medical record release authorizations

• Tracks clinical information (contacts, referrals, treatment plans, and more)
• Automatically verifies member insurance coverage before allowing authorization of services
• Graphically displays authorization data over time and across levels of care
• Web-based add-on feature enables secure data review and exchange using the Internet

• Records contact and contract information about providers and payors
• Helps you monitor your provider network
• Supports payor account management
• Supports rate schedule information for your providers

• Processes claims to validate proper payments
• Minimizes the occurrences of duplicate payments
• Calculates outstanding and anticipated claims liability
• Tracks adjudication status
• Provides explanation of benefits and remittance advice to justify adjudication processing

• Monitors cash flow and controls payments
• Includes online accounts payable and check processing
• Integrates processes—from adjudication to payment