Stratigic Insights

MCC Core System Architecture

Conceptual Flow Diagram

PROVIDERS

Hospitals, Clinics, Labs

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CLAIMS SUBMISSION LAYER

(Clearinghouses / APIs / EDI)

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DATA NORMALIZATION ENGINE

X12 → Unified Schema

FHIR → Unified Schema

JSON → Unified Schema

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UNIVERSAL RULE ENGINE

Deterministic execution of:

• Eligibility rules

• Benefit logic

• Coding edits

• Contract rates

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STANDARDIZED DECISION OUTPUT

• Allowed amount

• Patient responsibility

• Payer payment

• Explanation codes

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TRANSACTION LEDGER

Full audit trail of rule execution

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BATCHING & SETTLEMENT ENGINE

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PAYERS / PAYMENT SYSTEMS