MCC -Questions & Answers
Strategic, technical, financial, regulatory,
and operational questions
SECTION 1 — VISION & MODEL
1. Explain MCC in one sentence
Answer:
MCC is the healthcare version of DTCC — a single clearing engine that processes claims instantly, accurately, and at a fraction of today’s administrative cost.
2. Why hasn’t anyone done this before?
Answer:
Because the tech, standards, and political readiness weren’t there until now. FHIR APIs, universal coding rules, cloud infrastructure, and consolidated health systems make this possible for the first time.
3. Does this replace insurance companies?
Answer:
No. MCC reduces friction between insurers and providers.
Insurers still own plan design, networks, actuarial risk, and premium revenue. We just standardize how claims get processed.
4. What’s the killer advantage here?
Answer:
The clearing model makes complexity irrelevant. Every provider sends one type of claim. Every insurer receives one type of decision. MCC removes billions in duplicated administrative labor.
SECTION 2 — TECH & PRODUCT
5. How do we handle different payer rules?
Answer:
We store each payer’s rules in a unified rules engine. All variation, deductibles, bundling edits, and prior authorization logic are processed by a single engine. This gives standardization without forcing insurers to change their policies.
6. How accurate is MCC compared to current systems?
Answer:
In shadow mode, we tune MCC until we match payer determinations 98–99% of the time. Then we flip to live payments.
7. What about edge cases, rare procedures, or complex claims?
Answer:
Version 1's pilot excludes high-complexity inpatient claims. We start with outpatient professional procedures where rules are consistent and predictable. As MCC learns, we expand.
8. How will we integrate with provider EHRs and payer systems?
Answer:
A simple API gateway — providers can send X12, JSON, or FHIR. Payers receive standardized adjudication payloads. Integration is trivial compared to typical EHR projects
9. What about fraud detection?
Answer:
Version 1's pilot uses basic heuristics — frequency anomalies, mismatched coding. V2 uses machine learning on statewide claims patterns. Fraud reduction becomes one of MCC’s biggest ROI drivers.”
SECTION 3 — FINANCIAL & BUSINESS
10.What’s the ROI for insurers?
Answer:
Administrative cost per claim drops 30–50%. Payment accuracy and fraud reduction improve significantly. Provider satisfaction skyrockets, which reduces churn and disputes.
11. What’s the ROI for the state?
Answer:
Medicaid spends billions on administrative overhead and appeals. MCC provides transparency, instant adjudication, and auditability at a fraction of the cost.
14. How does MCC scale nationally?
Answer:
We start with Utah, expand to Colorado, and then to California. Each state adds more payers, more providers, more data, and deeper rule coverage. Once three states run on MCC, national adoption becomes the default.
SECTION 4 — RISKS & ROADBLOCKS
15. What’s the biggest risk to the project?
Answer:
Resistance from insurers who fear losing control. We neutralize that by giving them governance seats, oversight of the rules, and financial incentives for participation.
16. What if hospitals don’t want pricing transparency?
Answer:
We’re not setting prices — we’re enforcing existing contract rates. MCC is a tech layer, not a rate-setting authority. Hospitals actually get paid faster, which solves their cash flow issues.
17. What about liability if MCC makes a mistake?
Answer:
MCC has a correction window, just like financial clearing systems. We also carry errors & omissions insurance and stop-loss reinsurance. The liability model is identical to that of clearinghouses in other industries.”
18. What prevents a large insurer from building this themselves?
Answer:
They already tried — every major insurer has its own clearing logic. The point of MCC is neutrality. Providers reject insurer-run systems because they are not trusted.
19. What if federal regulators push back?
Answer:
We’re not replacing Medicare systems; we’re providing a more efficient state-level infrastructure. CMMI actually wants experiments like this. We’re aligned with federal cost-saving mandates.
SECTION 5 — TEAM & EXECUTION
20. Who builds this?
Answer:
A hybrid team with deep expertise in:
clearinghouse engineering
healthcare billing systems
actuarial science
enterprise API architecture
compliance/security
21. How long until Utah is live?
Answer:
Shadow mode: 6–9 months. Live payments: 12–15 months, depending on integration speed.
22. Why start in Utah?
Answer:
Unified health systems, clean data, rapid regulatory cycles, and leadership enthusiastic about modernization. Utah gives us a fast-win environment.
23. What’s the long-term vision?
Answer:
A national clearing utility that sits between every provider and every payer. The backbone of healthcare transactions.
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The MCC applies the world’s most efficient financial-clearing technology
to the most wasteful part of American healthcare.
It is a bipartisan, private-sector modernization that cuts costs, speeds payments,
simplifies billing, and saves hundreds of billions—without disrupting coverage or raising taxes.