UTAH PILOT OVERVIEW

Overview

The Medical Clearing Corporation (MCC) is a proposed neutral infrastructure layer designed to standardize how healthcare claims are interpreted, processed, and prepared for settlement between providers and insurers.

MCC applies existing payer policies deterministically through a universal rule engine, producing consistent and transparent claim determinations. The system does not alter care delivery, benefit design, or reimbursement policies.

Pilot Objective

The Utah pilot is intended to evaluate whether standardized rule execution can improve consistency, transparency, and administrative efficiency in healthcare claims processing.

Pilot Structure

The pilot will operate in a controlled “shadow mode” environment. Participating organizations will continue to use existing claims systems while a parallel MCC process evaluates claims independently.

The pilot will not affect live claims adjudication or payment flows.

Scope of Participation

Participants may include:

• Healthcare providers (hospitals, clinics, health systems)
• Insurers / payers
• Medicaid program stakeholders

Participation at this stage is limited to evaluation and does not require operational changes to existing systems.

What the Pilot Evaluates

• Consistency of claim interpretation across similar cases
• Transparency of decision logic and outcomes
• Reduction in administrative ambiguity and rework
• Time required to generate complete and auditable claim determinations
• Feasibility of integrating standardized rule execution alongside existing workflows

‍Potential Benefits

‍For Providers:
• Reduced claim ambiguity and rework
• Greater clarity in reimbursement outcomes
• Improved administrative efficiency

‍For Insurers:
• Consistent execution of payer policies
• Reduced disputes and administrative friction
• Improved transparency in claim decisions

‍For the Healthcare System:
• Improved transaction consistency
• Enhanced auditability and oversight
• Potential long-term reduction in administrative cost

‍Current Status

‍ Initial concept development is complete.
Outreach to Utah healthcare stakeholders is underway to assess interest in pilot participation.

‍Organizations interested in the pilot may:

‍ • Participate in an initial discussion
• Review pilot framework and technical approach
• Provide a non-binding letter of interest to support pilot exploration

For more information