Health Care and Insurance

Muscato Group has a 23 year history of using next generation software to successfully provide global transaction processing solutions. Our transaction processing software is licensed to Fortune 500 companies in dozens of installations and facilitates tens of billions of annual transactions.

Muscato Group' intelligent messaging infrastructure delivers healthENGIN^TM, a single-source solution for connectivity, translation and interoperability in a scalable, flexible, cost-effective and proven all provider, all payer, all transaction system.

healthENGIN^TM processes EDI and proprietary healthcare claims, payments, eligibility and payment inquiries, submits patient information safely across networks, and enables full HIPAA standards compliance including the latest 5010 transactions.

healthENGIN^TM processes 200 million healthcare transactions a year for a consortium of Blue Cross Blue Shield organizations and other insurance providers.

HIPAA

• 5010 transaction format and edit libraries
• Standard delivery of ready-to-use solutions to meet compliance and testing timelines
• Support 4010A1 and NCPDP best practices concurrent with ramp-up to 5010
• Rapid deployment of all standard formats through preconfigured libraries
• Implementation model for deployment of standard transaction flows

Proven Technology

• Existing payer installed base
• 23 year history of successfully deploying flexible architecture to provide global solutions
• Multi-tier architecture enables cost-effective, scalable solutions
• Single configuration supports real-time and batch processing
• Browser-based user tools enable rapid deployment and lower administrative costs

Trading Partner Management

• Total onboarding solution for 5010 migration
• Accommodates multiple secure file transfer methods for trading partner base through single management point
• Provider-facing services
• Secure web-based file transfer

Robust Features

• Configurable rules for transaction acceptance, translation and delivery
• Any-to-any translation of X12, NCPDP and flat-file formats
• Rule-based multi-tier editing and validation, configurable by trading partner
• Real-time browser-based support tools

Communication Managers	A complete message queuing environment to manage claims processes, workflows, HIPAA transactions and other system interfaces.
Authentication	Authentication challenges every user for their ID and credentials, then admits or rejects them based on the accuracy of the response.
Authorization	The trading partner is authorized to perform functions within the system such as submit claims, receive acknowledgements, inquire about claim status, and more.
Structure Validation	Assures HIPAA compliant format and structure. ENGIN is certified, in conjunction with Muscato Group's customers, consistent with industry standard compliance levels.
Routing	Routing is configuration and profile driven, ensuring rapid and efficient processing.
Payer-Specific Edits	healthENGINTM contains sets of HIPAA payer-specific edits and additional rules that can be easily configured using intuitive GUI tools rather than custom coding.
Translation	Powerful, single pass translation achieves high throughput and productivity for users. Pre-defined mapping and translations speed implementation, testing and production.
Rebatching & Distribution	Re-batching is based on multiple, complex criteria. Distribution can be instantaneous or delivered according to pre-determined delivery instructions.
Real Time/Batch Capability	Muscato Group' ENGINTM provides both real-time and batch capability. Organizations can migrate between both using one integrated solution.

M2 and Blue Cross Blue Shield's Healthcare Data Interchange Group (HDIG)

Through partnership with the Healthcare Data Interchange Group (HDIG), a consortium of 7 Blue Cross Blue Shield organizations, M2 has helped to establish a set of best practices that encapsulate HIPAA certifiable administrative transactions. These best practices have been directly incorporated into M2's healthENGIN, allowing members to move quickly through the 5010 HIPAA implementation, testing and production environments. One of M2's clients became the first Medicare intermediary in the country to put the HIPAA- compliant X12.837 Institutional Format into production.