Parity-Sync


Parity and Change Management in Managed Care Operations

There is a wide range of changes that need to materialize in order to assure compliance with the MHPAEA IFR. The timeline for making changes is adequate, though there is little time to waste. InfoMC can satisfy your technological needs through our Parity-SyncTM configuration product. In addition to the assistance InfoMC will offer with respect to the technological and software configuration changes that are needed, we also want our clients to be able to access industry expertise quickly and affordably to support the changes in your business. It is for that reason that we are bringing to bear the additional consulting expertise of AHP Consulting Group and Criterion Health.

InfoMC’s Technology and Configuration Solutions to Comply with MHPAEA


1. Plan Design including Claims Processing and Scope of Service Changes

In order to comply with the Single Cumulative Financial Limitation from the MHPAEA IFR InfoMC has developed Parity-SyncTM, a configuration tool will allow you to send and receive files containing information about shared financial limitations. The tool will support any file layout requested by the health plan and will update your systems to ensure claims processing can occur accurately. InfoMC’s professional services team is available to assist you in configuring the tool to meet the unique needs of your business.

Comply with the following:

  • Definitions of “substantially all” and “predominant”
  • Communicating changes among plan members and providers
  • Developing Classifications of Benefits
  • Changing determination of UCR
  • Selecting covered conditions and applying generally
    • recognized medical standards
  • Establishing covered services, types of care and corresponding provider types
  • Changing professional standards for providers
  • Aligning State law and health plan policy

2. Medical Management and other Non-Quantitative Limitations

The MHPAEA IFR will require your medical necessity criteria and guidelines to be normalized with those used for medical purposes. InfoMC’s Parity-SyncTM will allow you to store your criteria and guidelines within your system to ensure efficient and consistent decision making.

Adapt to the following:

  • Discontinuation of EAP as Gatekeeper
  • Level of care/medical necessity guidelines, criteria and processes normalized with those used for medical purposes
  • "Fail first" and completion of treatment rules

3. Disclosures

MHPAEA includes two new disclosure provisions that you will need to implement. InfoMC’s Parity-SyncTM will allow you to send disclosures that include your criteria for medical necessity determinations as well as the reasons for any denials of service as required under the MHPAEA IFR.

Develop the capacity to deliver:

  • Medical necessity criteria to plan members and providers upon request
  • Reasons for denial of reimbursement

Deliver Together

Together InfoMC, AHP Consulting Group and Criterion Health can deliver unparalleled depth of expertise in many important business, technical and clinical domains, and experience in the field. In addition to InfoMC’s Parity-SyncTM solutions, complementary consulting services provided by the AHP Consulting Group and Criterion Health include:

  • Assessment and Gap Analysis of business and clinical operations in relation to the MHPAEA IFR
  • Business process assessment and reconfiguration of workflow, forms and business rules in accord with the IFR
  • Implementation management and independent validation