How MCC Works

MCC functions as a clearing and decision engine
between providers and payers.

1. Intake & Normalization

Claims arrive in X12, JSON, or FHIR formats

MCC converts all incoming data into a standardized internal schema

This eliminates formatting inconsistency across payers

2. Universal Rule Engine (URE)

Each payer’s rules are stored as structured modules:

• Eligibility rules

• Benefit design logic

• Coding edits

• Contracted rate schedules

Rules remain owned by payers

MCC applies them consistently and transparently

3. Decision Output

MCC returns:

• Allowed amount

• Patient responsibility

• Payer payment

• Clear explanation of codes

• Flags (if needed)

No black-box denials - No inconsistent interpretation

4. Settlement (Live Mode)

Shadow mode first, until 98 to 99% accuracy is achieved 

Live mode triggers payment instructions through existing ACH/EFT systems

MCC is not a bank. MCC is not an insurer. MCC executes

For technical specifications: