What may be considered the finest, fastest Contract Modeling and Decision Support system for Hospitals, Health Systems and large Physician Practices!

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Contents
 Client Comments (3)
 Overview (4)
 AllPayor System Benefits (5)
 Calculate the Plan Benefit (6)
 Collect Pay Differences (7)
 Record the Contractual Allowance (8)
 Model Contract Proposals (9)
 Software Specifications (10)
 Unique Features (11 & 12)

3. Client Comments
 “MHP issued SSM a settlement check for $408,000 on 06/03/09. This is the first
part of an ongoing process, there are additional settlement amounts in the future.
(SSM)
 “Ken, just to let you know, we picked up an additional 8% on our contract
negotiation! Thanks for your help modeling their initial proposal. (UMISS)
 “I've been comparing PCON to MCA and to make a long story short, the vast
majority of errors appear to be in PCON. For example, all of the CT scans in PCON
are calculating incorrectly (since August). Another big chunk of PCON errors are
due
to rates that were not updated. Another chunk are due to an outdated PCON
radiology fee schedule. And so on. (SSM)
 “FYI, during the set-up of the new MCA tool, MCA identified 20 Medicare inpatient
accounts as under paid due to an error at Medicare. We initiated the appeal
process with Medicare and just received an additional $192,000 for these
accounts!!! Just during the install!!! (HCHD)
 “The staff at MCAnalyTXs are wonderful, they support you every step of the way.
The system is very user friendly and everything is at your fingertips. The system
has already identified several underpayment opportunities for us.” (Nix)
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Overview
The AnalyTXs AllPayor System is designed to solve four
major hospital problems
Calculate the plan benefit expected from all Payors and
compare that expected benefit to the actual payment
received. Then collect system identified underpayments.
Create instant models using "what-if" clones of existing
contracts and apply them directly to hospital claim data.
Instantly evaluate contract proposals for your unique case
mix.
Create price quotes that create a prototypical “bill” from
hospital’s data, priced at their negotiated contract terms for
any payor and that reflect the patient’s net “out-of-pocket”
cost of the service.
Record the period-end contractual allowance for unbilled
and in-house charges (exceed Sarbanes-Oxley standards).

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AllPayor System Benefits
 Make sure all claims are paid in accord with the contract –
collect underpayments before deadlines pass.
 Identify internal billing and record keeping issues that
cause claim underpayments/denials – improve cash flow.
 Book a period-end contractual that is developed in a
logical, auditable and consistent manner – avoid financial
disaster.
 Negotiate rates from a position of strength. Evaluate the
overall net affect of the proposed blend of rates, weights
and factors – know the bottom line before signing the
deal.
 Analyze net benefit by facility, by plan, by strategic
business unit, even by Physician. Sift out opportunities
and act before the rest of your community – be pro-active.

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Calculate the Plan Benefit
 Easy Plan Term Set-up
 Either MCA’s staff or the hospital’s staff may set-up the
contracts (no special off-site training) – the hospital’s option.
 Point and click contract terms “tool box” and plan cloning
make loading plans fast and easy.
 Easy Data Acquisition
 MCA accepts all 837 or print image UB-04’s from the
hospital’s claim editor each day – day forward and/or
retrospectively as well as 835 payment data and/or print
image daily payment posting data.
 MCA accepts claim and payment data “as is” so vital hospital
Information Systems resources are not burdened.
 As plans are set up, claims are flagged to pass from a hold
file into the AnalyTXs AllPayor System automatically –
unflagged claims are held forever and move in as flagged – a
real advantage for new or modified plans.

7. 7
Collect Pay Differences
 Easy Payment Difference Identification
 Real-time payment difference reporting – reports high to
low differences – by plan, by facility, by biller, etc.
 Click on any difference – drill down to the detail claim level.
 Easy Payment Difference Adjudication
 From a drop-down menu at the claim level select any
adjudication letter – infinite letter possibilities.
 Click on any letter and it immediately contains all of the
patient specific information – amounts due – authorization
codes, payor mailing address etc.
 Write a note or click a “park code” to flag the claim for later
review, mail the adjudication letter and you are done.

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Record Contractual Allowance
 Contractual Allowance For Filed Claims
 As each claim is filed, the AnalyTXs AllPayor System
automatically computes the plan specific write-off.
 Multiple claims, late charge claims, replacement claims, DRG
and Payor changes are automatically consolidated and
adjusted according to plan specific rules. Write-off amounts
are being updated by daily claim filing.
 Contractual Allowance For Unfiled Claims
 Easily populate the AnalyTXs AllPayor System with the period-
end inventory of in-process claims.
 System uses dynamically self-adjusting filed claim write-offs
by Payor to calculate the period-end GL adjustment.
 Click option to permanently lock the period as proof against
subsequent number tampering – Sarbanes-Oxley sound.

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Model Contract Proposals
 Model Contracts the Day They are Received
 Clone a similar plan – takes less than a minute.
 Click the toolbox to add or delete plan provisions.
 Enter the newly proposed dollar amounts or percents in the
tables invoked by the tool box.
 Select as a base for the model any existing plan that mirrors
the utilization patterns of the proposal.
• Use same plan if you are modeling rate updates.
• Use any plan to contrast the effect of new contract terms
applied to its utilization patterns.
 Run reports to see the net gain or loss from the complex
interaction of the proposed terms.
 Adjust and repeat as necessary – develop counterproposal
strategies – You can even gage the value of a counter offer
while meeting with the payor representative.

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Software Specifications
 Oracle Application Server 10g provides an optimized ASP
Web platform. Service access is delivered through
enterprise portals and mobile devices for real-time
business intelligence.
 Oracle Forms and Reports provide unrivaled scalability and
security.
 Claim and Payment data enter the system through a client
specific, password protected, 128 bit encrypted VPN tunnel
to an FTP site behind a firewall.
 Each individual user has application level hospital defined
privileges, and unique usernames and passwords that
reset at client specified intervals.
 Can be used by one or hundreds of hospital employees at
no extra charge per terminal. Can be accessed from home
or while on the road.

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Unique Features
 Drill down query by revenue code, HCPCS code, DRG,
diagnosis and procedure code. No special analyst or
programmer required.
 Model within the system against actual claim data. No
need to create extracts or downloads. Done in minutes.
 Rapidly compare rates among payors to identify winning
contract provisions. A quick comparison of contracts by
product line can clarify negotiation strategy.
 Set up and use park codes to temporarily or permanently
set aside claims or groups of claims. Manage projects
easily.
 Data is on-line forever. Nothing is striped or archived so
every claim and every payment is available as long as you
are a client.

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Unique Features - Continued
 Electronic contract image stored on-line.
 Users can manually override system generated stop loss,
and add implant, prosthetic and high drug invoice
amounts if necessary.
 Full claim history on-line. See (and print) the entire UB-
92 for the initial claim and all subsequent claims (late
charges, replacement claims etc.)
 Complete payment history on-line for every claim for
primary and secondary payments. Click on each payment
and drill down to the remit.
 Remote storage of claim data in our functional database is
like having an active backup in the event of a disaster.
 No per-contract set-up or maintenance charge. 1 or 1,000
contracts, the monthly price is the same.