Secure solutions to pinpoint clinical and financial opportunities and succeed in complex regulatory and reimbursement environments inherent to Medicaid contracts.
Organizations serving Medi-Cal or state Medicaid beneficiaries operate under challenging financial and regulatory conditions. Investing in streamlined claims administration system designed for alternative payment models can help you efficiently manage the nuances of Medicaid capitation and sub-capitation agreements.
Our care management and claims administration capabilities are designed to handle the complexities of capitation. We help you manage multiple provider contracts with a single ID to track and administer payments based on specific contract parameters that apply to each provider within your network. Easily reconcile payments and get alerts for potential under- or overpayment. Our integrated care management capabilities also support authorization and letters management workflows.
Leverage our analytics application to proactively identify priority and dual-eligible populations at higher risk for disease. Act on the insights by placing high-risk cohorts into care management programs.
Our data team can work hundreds of data vendors, sources, and types to normalize and make member and provider information available for the applications on our platform, or seamlessly integrate with other point solutions in your technology ecosystem. Experience the seamless transition between information, insights, action, and administration with our analytics, care, and payment tools. We help everyone – business analysts and actuaries, care managers and providers, and claims processors and finance teams – act on the same data set for a better member experience.
Easily manage strict contract and regulatory requirements for processes (such as prior authorizations) with our integrated provider portal, letters management, and documentation tools. Track all care management activities at the administrative level, and pre-configure time-sensitive activities to reduce the likelihood of noncompliance. Robust provider analytics and sharable reports ensure that providers have visibility into their performance with respect to clinical and plan goals.
Manage priority cohorts dynamically and place them into appropriate care pathways with our integrated Analytics and Care tools. With task and time tracking, care plans, questionnaires, and integrated communication tools, your care managers have a powerful resource to make workflows more efficient. The ability to automate repetitive or time sensitive processes minimizes process errors and supports regulatory requirements.
Identify ways to improve health and control costs by understanding member-level characteristics and opportunities with predictive models, utilization, social needs, and quality and risk measurement data. Look at your Medicaid population in new ways when you leverage our advanced analytics capabilities and predictive models for diabetes, breast cancer, and other conditions and behaviors. Apply demographic, SDoH, and deprivation index filters to target services and render appropriate care.
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