MCEL™
Overview
The MCEL system assists healthcare providers in identifying and documenting all of their potential Medicaid eligible patients and the type of Medicaid eligibility that each patient has. The system provides auditable and verifiable supporting information for DSH calculations, based on a facility’s actual data — NOT estimates. If you are audited by the OIG, you will need your facility’s actual and verifiable Medicaid metrics. MCEL automatically matches eligibility codes to determine what portion of the reimbursement is eligible. Here is how MCEL works.
First, the system identifies all of a facility’s Medicaid eligible patients regardless of their payor status. This information is used to ensure that the collection process accounts properly for any patient that has a retroactive adjustment or change to their Medicaid eligibility. In addition, the system identifies all of the Medicaid eligible patients that may also have coverage under another payor type for proper use in determining the Medicare DSH for the facility.
The business office provides a download file of ALL patients discharged.
Method 1 – Via the state’s Medicaid eligibility website (POS).
Each patient is verified against the state’s website. When a confirmation of eligibility comes back, the system saves the eligibility verification (POS slip) in an HTML file format for viewing and printing at any time. When a conditional confirmation of eligibility comes back, the system performs an analysis based on the type of conditional eligibility to identify the patients who have met the conditions and are eligible (i.e. if the patient is eligible for maternity services only, the system will look at the patient’s ICD-9 diagnosis to determine if this patient was covered for maternity services). If the patient meets the conditional eligibility, the system saves the eligibility verification (POS slip) in an HTML file format.
Any patient that does not receive a confirmation can be re-checked as often as desired until the Medicaid system drops the information from the website. MCEL will save the responses from the website to ensure that you are able to view and print the patient’s Medicaid status returned from the state, for all of your patient records.
Method 2 – Via the state’s file submission services.
In using this method, all patient records are imported into MCEL. Once imported, the system will produce a submission file that is created to the exact specifications delineated by each state. After submitting this file to the state, you will receive a results file. This results file is then imported back into MCEL. The system will match the exact Medicaid status provided by the state to each individual patient record. Conditionally eligible patients are again checked against specific criteria (i.e. an ICD-9 diagnosis to cover maternity services), to deem their exact eligibility status.
Results from either POS or file submission are easily reviewed through reports that can be created in PDF, CSV, or HTML formats.
States currently supported by MCEL are as follows:
- California –
- POS – (from previous 13 months to current)
- Submission file – (anything older than 13 months)
- Florida
- Georgia
- Louisiana
- Pennsylvania
- Tennessee
- Texas
MCEL™
System Requirements
MCEL is an inTRAnet based server application.
The server is placed on-site and available via TCP/IP behind your firewall.
Access to the server/application is gained via company LAN/WAN.
Server Hardware/Software Requirements
- Operating System: Windows 2000, XP or Windows 2003 Server.
- 2GHZ CPU or faster.
- A minimum of 1GB RAM (2GB preferred).
- Hard drive space:
- The application requires 5 megabytes of disk space.
- Storage of facility data requires approximately 400 megabytes of disk space per 10,000 patient discharges.
- A 100GB or larger hard drive is suggested.
- Network connection to LAN and/or WAN.
Client Hardware/Software Requirements
- Ability to run Microsoft Internet Explorer version 6.0 or above.
- TCP/IP access to the server machine over company LAN and/or WAN.
- Ability to connect to the internet (if being used to run web based Medicaid verification).