Managed Care Organization Conversion

Building a Successful Managed Care Organization (MCO) with Managed Care Consulting Experts

BHM is the nation’s leader in Managed Care Consulting.  In the past five years we have assisted over a dozen MCOs and their legacy organizations not only transform into a Managed Care Organization, but financially thrive in the MCO environment.  Our targeted approach can assist your organization from application, to organizational change implementation,  to end performance monitoring.  We offer a holistic approach with skilled experts in financial, clinical, and operational improvement to assist you every step of the way in your MCO Conversion.

A History of MCO Success

  • 100% Success Rate for MCO Application Submissions
  • Over 10 Successful Client Mergers in the Past Three Years
  • Development of Award Winning Call Centers and Recognized Provider Networks

[icon name=”icon-arrow-right”] Click here to view a case study about our success with an MCO client! [icon name=”icon-arrow-left”]

Preparing to become an MCO BHM Services
Application Process (RFI Process) With a dedicated team of proposal writers and a deep understanding of MCO requirements, BHM partners to craft documents for successful submission and acceptance. BHM has achieved a 100% success rate with MCO application submissions.
Mergers Mergers required of many MCOs can be cumbersome and time consuming. BHM assists by building a work plan, organizing committees, and providing resources that focus solely on the merger task. Our team of financial and legal experts are adept at making the process fluid and efficient and have assisted with more than 10 successful mergers since 2010.
National Accreditation/Certification BHM has a 100% success rate in assisting our clients in achieving their desired accreditation, and has assisted companies in navigating the accreditation process simultaneous to both mergers and transformation successfully.
Project Management and Support BHM has custom project management software and dedicated certified project managers who are experienced with MCO Conversions who will build a realistic work plan, communicate milestones, and ensure goal completion on time and within budget.
Network Operations BHM has assisted in building provider networks for some of the largest Managed Care Entities in the nation, including set up of credentialing functions and identification of vendors.
Service Delivery Service Delivery and Support are areas of primary focus, and one of the most challenging hurdles for many MCO Conversions. We have these areas down to a science and have assisted in setting up claims shops, establishing call centers, and providing appropriate support and infrastructure for both members and providers during the conversion process.
IT Infrastructure BHM has the technological expertise to shape and build your core engine in order to process and adjudicate claims; provide deep data reporting on daily metrics and other key indicators; calculate IBNR and other revenue reports, and provide clinical touch point data reporting.
Operations BHM is experienced in assisting with clinical and non-clinical design; development of effective work flows; and Policy & Procedure Development.
Finance BHM’s financial experts will help you navigate MCO and Provider Contracting, provide financial forecasting and IBNR calculations, and assist you with not only setting up a solid revenue structure, but boosting organizational performance.
Understanding Reform Is Critical. Find Out Key Impacts With This Industry Leading Brief!

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