MCRA Members

Growing a business in today's siloed health plan environment is very challenging. MCRA can be a valuable resource for outreach and growth initiatives. MCRA builds partnerships among Members of the Alliance. Active participation and willingness to support other Members facilitates strong relationships and new opportunities.

DRG Claims Management

Payment Integrity Audits

DRG Claims Management (DCM) has been offering cost containment solutions to health plans across the United States since 2013. Services include post-payment model focused on addressing inaccurate coding and clinical errors retrospectively, maintaining good relationships with providers, and ensuring a smooth refund request process. DCM's prepayment model is preferred by health plans to prevent overpayments, reduce turnaround time, increase provider response, and ensure the audit of out-of-network claims.

WHY DRG CLAIMS MANAGEMENT?

DCM differentiates from their competitors with customizable solutions and customer service. They offer their clients white glove services, with the following metrics

$20 PMPM Savings: Strategic impact on cost reduction.
40% Audit Hit Rate: Nearly one-third of all records audited lead to actionable insights.
96% Medical Records Acquisition: Effectively obtaining the necessary documentation.
95% Accuracy Rate: Precision underlines every audit decision they make.