Communities without barriers - MTM, Inc....MTM’s contact centers continually exceed National...
Transcript of Communities without barriers - MTM, Inc....MTM’s contact centers continually exceed National...
Communities without barriers
w w w. mt m - i n c. n e t
Founded in 1995, MTM was born out of the need
for centralized management of non-emergency
medical transportation (NEMT) services. Helping
the disabled, elderly, and other transportation dis-
advantaged populations with their transit needs
is the core of our operations. An industry-leading
NEMT manager, MTM leverages our extensive
knowledge of the transportation and healthcare
industries to deliver fresh approaches for increas-
ing access to healthcare.
Through our diverse product off erings, MTM helps
clients meet challenges that are often left unful-
fi lled while collaborating to align incentives, re-
duce costs, and increase satisfaction. This approach
directly supports our core mission of increasing the
wellbeing of the populations we serve by remov-
ing community barriers, promoting independence,
and improving health outcomes.
MTM Footprint
New Jersey
New YorkR.I.
Mass.
Conn.
N.H.
Maine
Pennsylvania
Del.Md.Washington D.C.
Vt.
Washington
ArizonaNew Mexico
Texas
Oklahoma
KansasColorado
Utah
Nevada
California
Idaho
Montana North Dakota
South Dakota
Nebraska
Minnesota
Iowa
Missouri
Arkansas
Mississippi
Louisiana
Florida
Georgia
Tennessee
Wisconsin
Illinois Indiana Ohio
Michigan
Kentucky
Wyoming
Virginia
VirginiaWest
CarolinaSouth
Ocean
NorthAtlantic
North
OceanPacific
Hawaii
Oregon
North Carolina
MTM headquarters
MTM customer service centers
MTM Business offices
Indicates states in which MTM operates
Across the country, MTM’s clients gain process effi ciency, cost containment, and
improved customer service with our proven management methods. Since be-
ginning our operations in Missouri in 1995, MTM has quickly expanded nation-
wide. With our vast presence, MTM has the ability implement new programs and
provider networks seamlessly and effi ciently.
Every year we schedule more than ten million trips and
service encounters for eight million members. Through
our nine customer service centers, we fi eld approximately
eight million calls with the utmost attention to high quality
customer service. We currently have a varied client base,
including contracts with:
Managed care organizations and health plans
State and county governments
Transit agencies
Area Agencies on Aging
Health and human services departments
Care Management
As one of the fi rst NEMT managers
to deploy a care management ap-
proach, we provide person-centric
care, enhanced coordination, and
positive outcomes in each of our
service areas. In particular, our Care
Management department gives ex-
tra attention to members with high
risk medical needs, providing exten-
sive care coordination to ensure their
health and wellbeing.
Customer Service
MTM’s contact centers continually
exceed National Committee for
Quality Assurance (NCQA) standards
and provide multilingual services
on a 24/7/365 basis. With specially
trained agents dedicated to each
service area, MTM leverages high
quality resources to provide mem-
bers with exceptional customer ser-
vice while delivering value to clients.
Network Management
By building and maintaining
networks of high-caliber service
providers, MTM off ers consistency
and quality in all areas of network
management—from recruiting,
negotiating rates, contracting, and
credentialing to reviewing claims
and processing payments—to es-
tablish solid networks. Our methods
ensure we meet the needs of clients
in both urban and rural locations.
Advantage
24 7365
Technology
Technology is the heart of MTM
operations, enabling automation,
protocol adherence, error reduc-
tion, and instant access to data.
Our systems were custom built and
include web-based portals, giving
stakeholders on-demand access to
data and service requests. Addition-
ally, our contact centers are linked,
preventing downtime and allowing
automatic call rerouting.
Fraud & Abuse Reduction
Looking for opportunities to provide
cost savings from every angle, our
proven processes and automated
systems methodically root out
fraud, waste, and abuse. Our staff
always verifi es member eligibility,
monitors service appropriateness,
and conducts regular audits to
ensure members receive necessary,
appropriate services that are
benefi cial to their overall health.
Quality
MTM strives to provide the high-
est level of service by demand-
ing quality from employees and
network providers. We are URAC
accredited and maintain satisfaction
rates exceeding 95%. To keep this
rate high, we are proactive in our
improvement eff orts by monitoring
service, performing audits, conduct-
ing weekly satisfaction surveys, and
addressing issues immediately.
Transportation Management
Care Coordination
Ambulance
Contact Center Services
Assessments & Travel Training
Services
Transportation Management
From sedan and ambulatory transports to higher levels of service such as wheelchair
lift and stretcher van, MTM schedules more than ten million trips nationwide each
year. Through our industry-best operating model that leverages comprehensive
network management, innovative technology, extensive cost savings, and excel-
lent customer service, we continually deliver effi ciency and high quality service for
a variety of diverse transportation programs. Thinking outside the box to provide
customized solutions that cater to our clients’ unique needs, MTM takes on diffi cult
transportation challenges and is a true one-stop transportation solution.
Non-Emergency Medical TransportationMTM developed one of the fi rst NEMT brokerage pro-
grams of its kind in Missouri in 1995, and has remained a
clear leader in NEMT management. We understand the
complexities of serving Medicaid and Medicare popula-
tions, including frail, elderly, and other transportation
disadvantaged passengers, and off er proven solutions
for coordinating their needs effi ciently.
Paratransit ServicesAs demand for Americans with Disabilities Act (ADA)
paratransit services continues to grow while budgets
tighten, innovative management is a must. MTM’s bro-
kerage model centralizes scheduling, assigns passengers
to lower modes of transportation, and maximizes un-
dedicated, existing networks of vehicles to contain costs
while increasing consistency and quality.
Worker’s CompensationGetting injured workers back to work begins by
getting them to the medical services they need.
MTM has a robust network of national transporta-
tion providers that ensures injured workers receive
timely, quality access to the care that will get them
back on their feet.
Special Needs & EducationFor school districts facing decreased budgets and
fl uctuating enrollment, coordinating transporta-
tion can be a costly, time-consuming process. By
outsourcing transportation to MTM, school systems
can stretch their valuable resources without sacrifi c-
ing the quality, safety, or reliability that is important
when transporting children.
MTM is your trusted partner for keeping members in place, in their own home or
community setting. Transforming the delivery of home and community based
services (HCBS) to serve a variety of populations, including individuals with men-
tal illnesses, intellectual or developmental disabilities, and/or physical disabilities,
is becoming more important. By providing services that promote independence
and remove barriers to care, MTM helps managed care organizations and
agencies improve members’ overall health and wellbeing while simultaneously
delivering cost savings.
Home & CommunityBased Services
Network Oversight
Network oversight can be a large
challenge. More so than any other
HCBS coordinator, we off er exten-
sive processes for managing service
provider networks. To ensure mem-
ber safety and satisfaction, each
vendor undergoes our rigorous cre-
dentialing process, inclusive of back-
ground and certifi cation checks.
We can even help you design these
credentials to meet plan require-
ments. We also ensure services are
rendered in a safe, timely manner by
performing regular fi eld monitoring
and inspection activities.
Quality Standards
MTM demands quality from our
network providers. We realize our
clients are held to high standards by
the Centers for Medicare & Medicaid
Services (CMS), and we help health
plans meet these stringent require-
ments by keeping close watch over
HCBS provision. To be proactive in
our improvement eff orts, we moni-
tor service, perform audits, conduct
weekly satisfaction surveys, and
address issues immediately. Quality
measures and outcomes are report-
ed on a monthly basis to ensure all
appropriate standards are met.
Encounters & Billing
Our fl exible system is capable of
paying providers for their services in
a timely manner. MTM is an expert
in coordinating billing eff orts, off er-
ing clients our ability to consolidate
claims from multiple providers into
a single monthly billing statement,
which saves a great deal of admin-
istrative time. We are also familiar
with developing encounter submis-
sions for health plans, and can assist
with matching claimed encounters
with approved services and service
frequency, checking appropriate
codes, and authorizing payment.
The Three Pillars of HCBS Coordination
AmbulanceStudies show that each year, approximately 25% of ambulance transports are
inappropriately utilized or billed—resulting in nearly $500 million in avoidable
costs. As more health plans face the increasing challenge to reduce inappropriate
expenditures, MTM delivers a centralized solution for non-emergent and emer-
gency ambulance services.
Built upon our extensive experience in the transportation industry, this well-
rounded approach provides up to a 25% reduction in ambulance claims expens-
es while increasing compliance and reducing fraud.
Ambulance Provider Network Management
By establishing comprehensive networks of credentialed
ambulance providers, MTM increases program quality
and passenger satisfaction. Providers must meet our
stringent requirements and are contracted at a standard-
ized, fair price. We provide ongoing education to ensure
understanding with our expectations, and facilitate
regular monitoring for compliance.
Prior Authorization & Medical Necessity Determination
Under our model, all non-emergent ambulance claims
must be prior authorized. As part of this process, we
conduct level of need assessments to verify a passenger’s
need for ambulance services. Following authorization,
we schedule transport with our network of credentialed
providers, supported by our 24/7/365 contact
center operations.
Claims Processing, Adjudication & Payment
Clients also benefi t from our centralized model for
processing, adjudicating, and paying ambulance
claims. We thoroughly review all submitted claims and
supporting documentation, including pick-up and
drop-off times and passenger signatures, to ensure
service was actually rendered and eradicate inaccu-
rate, fraudulent claims.
Appeals Management
MTM also has processes in place to manage provider
claims appeals in an appropriate, fair manner and
ensure the issue is resolved quickly. We maintain thor-
ough, accurate records of all claims documentation,
ensuring our staff can impartially assess the denial
while protecting against fraud. If the appeal is vali-
dated, we immediately issue payment to the provider.
Introduce newly eligible members to their health plan
Inform members of benefi t information
Provide education to reduce ER utilization
Re-enroll members close to benefi t expiration
MTM has managed customer service and member
outreach within our contact center operations since
our inception. Outside of scheduling and reservation
functions, our contact center solutions assist health
plans in reaching out to their members. Our expe-
rienced and trained representatives provide both
inbound and outbound calling to:
Contact Center Services
Experience & Reliability
Throughout our existing customer service centers,
MTM’s expert staff handles more than eight million
calls each year while maintaining industry-leading
satisfaction rates and exceeding client and NCQA stan-
dards. Our representatives are experienced in working
with members of various health plans, and are special-
ly trained to adhere to client-specifi c protocols. MTM
answers calls 24 hours a day, seven days a week, 365
days a year without interruption.
Technology & Effi ciency
With contact centers strategically placed throughout
the country, our locations are linked by an advanced
phone system that prevents down time and allows
calls to be seamlessly routed between locations based
on capacity and call volume. The system has the capa-
bility to transform calls into rich, multimedia experi-
ences customized to meet specifi c needs and criteria.
Available features include automatically segmenting
and routing calls, Interactive Voice Response (IVR)
technology, and meaningful reporting.
MEMBER
What is my deductible?
Will my appointment be covered?Do you have a
primary care provider?
That is a covered service.
It is time to re-enroll.
Welcome to the plan.
How can I get a new ID card?
Open the lines of communication.
Assessments & Travel Training
MTM’s healthcare and transportation knowledge helps us understand the goals of the
ADA paratransit eligibility process, as well as the complex issues that aff ect individuals
with disabilities and older adults. From this understanding, we developed our On the
Move program for assessment and travel training activities for transit agencies, commu-
nities, school districts, and other entities serving special needs populations. Through On
the Move, we help clients increase the independence of the populations they serve and
facilitate better access to the community.
Assessments
Instead of considering a medical diagnosis as a fi rm eligibil-
ity determination, our assessments focus on actual function-
al and cognitive abilities. Our qualifi ed, trained evaluators
utilize recognized tools such as the Functional Assessment
of Cognitive Transit Skills (FACTS) test to determine barriers
that may impact an individual’s ability to safely and inde-
pendently access public transit. On the Move off ers several
types of assessments, including:
ADA assessments
Special needs assessments
General mobility assessments
In all cases, assessments utilize the standards and meth-
odologies of national organizations such as the National
Transit Institute (NTI) and Easter Seals Project ACTION (ESPA).
Evaluations follow a comprehensive process to accurately
determine if an individual can safely access public transit
either with or without travel training.
Travel Training
For individuals who are capable of utilizing fi xed
route bus or rail systems but may require assis-
tance before doing so, On the Move travel train-
ers provide comprehensive instruction in real-life
transit scenarios to familiarize the individual with
local transportation options. Varying travel train-
ing services—including one-on-one, classroom/
group, and train the trainer—are customized to
help individuals gain new skills, overcome fears,
and build confi dence.
For the individual trained, increased confi dence,
self-reliance, and community integration are
immediate results of learning to travel indepen-
dently. Travel training also benefi ts the clients
and communities we work with by reducing
program expenses and paratransit utilization
while increasing the use of cost-eff ective public
transit systems.
5. 1. 2. 3. 4.
Application In-Person Interview and/or Assessment
Recommendation Travel Training Transportation Scheduled
Assessment process
BR-MTM-014-2014-2.0