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"I continue to be impressed with you guys and your ability to navigate the wonders of this system. I've been at this for over 30 years and have learned to be ever vigilant, you guys are tight!

Chip Callahan —
Partners Health Network

We are lucky when there are new updates with DMA, etc. AlphaCM makes the required changes for us… I am not dreading the ICD-10 implementation nearly as much because I know that we will have AlphaCM on our side.

Judy,
Cognitive Connections

[AlphaFlexCMS] has given our staff access to records in a much more efficient way so that they, in turn, may serve our participants more efficiently.

Jada —
Person Centered Partnerships

You all are awesome and your customer service is top notch! I recommend you to every provider I meet.

Kim —
Personalized Therapy, Inc.

AlphaMCS is fully web accessible and all features of the new system are operable regardless of the user’s operating system and web browser. With the further push of security, off-line capabilities and user experience that is more keeping with a desktop application, the system utilizes the latest Silverlight technology coupled with MS SQL Server 2008 R2. Silverlight has been successfully implemented in major corporations including Netflix and Continental Airlines and has been proven secure and efficient while providing a better user experience than traditional web-enabled applications. Additionally, AlphaCM, Inc utilizes the Microsoft Health Common User Interface current release of 8.2. Through extensive research, the Microsoft Health CUI Design Guidance and Toolkit controls, which have been selected for publication, have been identified as those that have the highest benefit for increasing patient safety and clinical performance within the healthcare industry. A rigorous, user-centered and iterative design, development process which incorporates regular reviews and feedback from a wide range of clinical and I.T. professionals, is used to create the Microsoft Health CUI Design Guidance and Toolkit controls. This ensures they conform to Best Practice, and their validity in meeting patient safety requirements.

Reliability

The ALPHAMCS system is a hosted environment to allow for ease of maintenance, version upgrades and problem resolution for all instances. AlphaCM, Inc expanded their existing relationship with Peak10 to utilize their Highly Available Enterprise Cloud Plus. Peak 10 is a managed services company with world-class data centers. It delivers scalable, economical and reliable solutions for hosting and managing complex information technology infrastructure. The company’s expert team embraces the industry's evolving technologies by adopting and tailoring solutions such as virtualization and cloud-based services as part of its robust managed services offering. Its strong customer focus, financial stability, geographic diversity and technical strength attract market-leading companies such as LendingTree, Global Knowledge, Pergo, Healthways, Churchill Downs and Carnival Cruise Lines. Peak 10 is SSAE 16 audited and helps companies meet the requirements of various regulatory compliance acts such as Sarbanes-Oxley (SOX), HIPAA, PCI and Gramm-Leach-Bliley (GLBA). Peak10 delivers and supports data center solutions locally from world-class facilities in South Florida, Jacksonville and Tampa, FL, Atlanta, GA, Louisville, KY, Charlotte and Raleigh, NC, Cincinnati, OH, Nashville, TN and Richmond, VA. ALPHAMCS is hosted at the Charlotte, NC facility with the ability to float to any of the other facilities in the case of an emergency. Peak10 also performs backup services and services monitoring to ensure 24/7 availability and disaster recovery.

Feature Set

The ability to manage care including demographic patients, provider applications and contracts, service referrals, service provision along with provider monitoring is critical to any MCO. The ability to manage care efficiently is paramount to the success of an at-risk MCO. Without a system that is built with the features and workflow design specifically for a multi-payer MCO, these tasks are impossible.

Feature set overview:

  • Patient Management
    • Patient Demographics including NC CDW elements
    • Benefit Information
    • Coordination of Benefits for Third Party Payers
    • Clinical Designations
    • Clinical Home Tracking
    • Problem List (ICD-9CM)
    • Substance Abuse History
    • Crisis Plan
    • Treatment Plan (PCP) Upload
    • Referring Provider Tracking
    • Chart Notes
    • Enrollment Status and Source tracking
    • Services History
    • Referral History
    • Ability tprocess/create 834 and process 820 Eligibility files in 5010 format
    • Ability tsend and receive 270/271 files in 5010 format
  • Managed Care
    • Call Management and referral appointment tracking based on location, specialty and contracted services provided.
    • Screenings Documentation including NC specific STR
    • Service Authorization Request tracking
    • Utilization Review Documentation and Audit Record
    • Industry Specific needs assessments including LOCUS/CALOCUS, ASAM and SIS.
    • Treatment Plan Tracking including NC specific PCP.
    • Track Hospitalizations
    • Manage Admission and Discharge into Services
    • Manage and Track target population groups
    • Ability to allow unmanaged visits
    • Client Budget Tracking, including NC Innovations specific requirements
    • EPSDT Tracking
    • Wait List tracking and Waiver slot management
    • Slot Scheduler
  • Service Provider Management
    • Service Provider Demographic tracking including sub-sites
    • Contracted Services tracking
    • Contract limit tracking
    • Specialty and Preference tracking
    • Negotiated Rate Tracking
    • Clinician Tracking
    • NPI and Taxonomy Mapping
  • Claims Processing
    • Automated Rules based claims processing with configurable rules
    • HIPAA Compliant claims submission including Direct Data Entry and 837P/I in the required 5010 format.
    • 997 response file creation
    • Claims Management screens with the ability to reprocess and the ability to
    • change claims processing results with permissions
    • Claims random audit sampling
    • Accounts Payable System Integration including integration to Dynamics GP.
    • Shadow Claims Processing
    • 835 and Electronic Remittance Advice generation
    • Industry Standard HIPAA compliant reason and remark codes.
    • Generation of 837P/I of clean claims for reporting to third party payer including IPRS and NC Medicaid.
    • Sliding fee scale and client deductible tracking
    • Benefit Plan maintenance
    • Clearinghouse claims routing
    • Void and Replacement Claims Processing
    • MUE (Medically Unlikely Edits)
    • Medicare Override Processing
    • SFTP of Claims related files
    • DRG processing
    • Payback and Recoupment processing
  • Quality Management
    • Complaint Tracking and Resolution Workflow
  • Provider Agency Portal
    • Direct Data Entry Claims Submission including CMS-1500 and UB-04
    • Service Authorization Request and Status Tracking
    • Enrollment and Referral Request including NC specific STR
    • Treatment Plan Submission including NC specific PCP
    • Crisis Plan Submission and Retrieval
  • Reporting
    • Canned Reports built in SSRS
    • OLAP Data cubes used for Dashboard and KPI's
  • Care Coordination
    • Progress Notes specifically PIE
    • Treatment Plan Creation including NC specific PCP
    • Treatment plan reviews
    • Consent Tracking
  • EDI
    • 837P/I incoming and outgoing
    • 835 incoming and outgoing
    • 997
    • 834 and 820 processing
    • 270/271
General Ledger Interface

AlphaMCS is developed to perform rules based claims processing. Given the nature of the development and the intent to give the ability to utilize best of breed technology, an interface to an agency’s chosen AP system will be developed. The current AlphaMCS system includes an interface to Dynamic GP utilizing currently available tools including eConnect. The interface includes the ability to send approved claims as invoices and recouped claims as credit memos. The interface additionally brings invoice payment information from GP to AlphaMCS including check number, date, amount and details that can then be utilized for 835 and remittance advice generation.