Utah Pilot – Controlled Rollout

 MCC begins with a limited-scope pilot.

Scope

• Outpatient & professional claims only

• No inpatient DRG in Version 1

• Limited specialty coverage

Target Participants

• Intermountain Healthcare

• SelectHealth

• Utah Medicaid

• 1–2 large employer plans

Phases

Phase 1 – Shadow Mode

Mirror claims and validate decisions.

Phase 2 – Limited Live Settlement

Turn on real payment for a defined slice.

KPIs

• Administrative cost per claim reduction

• Time-to-payment reduction

• Denial rate reduction

• Fraud detection improvements

• Provider satisfaction

Governance & Structure

MCC is structured as an independent,
stakeholder-governed entity.

Board Representation

• Providers

• Insurers

• Employers

• State representation

• Independent technical oversight

No single party controls MCC

Operational Layers

• Clearing Engine

• Rule Modules

• Settlement Layer

• Analytics & Audit

• Fraud Detection

High volume - Infrastructure scale