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Clinical Claim Reviews - Episode of Care Review FAQ

Clinical Claim Reviews - Episode of Care Review FAQ

Here are the most frequently asked questions about Gainwell's Episode of Care Review offering.

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Gainwell Company Overview

Learn how Gainwell Technologies empower clients everyday through innovative, purpose-built technologies and solutions to deliver great health and human services outcomes.
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Payment Analytics - Genetic Testing FAQ

Here are the most frequently asked questions about Gainwell's Genetic Testing solution.

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17 days ago
FraudCapture®

Gainwell Technologies uses cutting-edge tech to deliver future-ready fraud solutions. We combine innovation & experience to provide value beyond the margins of today's healthcare landscape.

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17 days ago
At A Glance - Gainwell Technologies

Gainwell Technologies is the leading provider of digital and cloud-enabled solutions to health and human services programs, supporting 56 million Medicaid beneficiaries.

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17 days ago
A Roadmap for the End of the Public Health Emergency - PHE Unwinding

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Preferred Drug List Management

Our dynamic and forward-looking approach to developing Preferred Drug Lists can help you reduce overall pharmacy expenditures and provide the best clinical value.

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Pharmacy Point-of-Sale

Our Pharmacy Point-of-Sale solution can help you control budget spend and administrative resource time while meeting federal and state requirements.

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Provider Solutions - Provider Credentialing

Centralized provider credentialing gives states control over the credentialing process, allowing enrolled Medicaid providers to be credentialed only once, saving money and reducing abrasion.

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Pre-payment Solutions

Gainwell's pre-payment solutions are comprehensive, compliant & configurable. See how we can help your organization minimize abrasion, alleviate administrative burden, and reduce claim spend.

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Enterprise Data Warehouse

Our centralized, cloud-based platform gives you the power of master data management, business intelligence & transformational analytics offerings that range from basic to advanced predictive modeling.

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PHE Unwinding - Whole Person Service

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7 months ago
Eligibility Verifications

Gainwell's comprehensive eligibility verification solutions include dependent eligibility, pension beneficiary, point of enrollment, working spouse provision, residency & non-smoking verifications.

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Residency Verification - Eligibility Verifications

Our residency verification solution prevents future erroneous payments through the identification of non-residents. Learn how.

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PHE Unwinding - Analytics

We're committed to helping you and your staff efficiently navigate the redetermination process - ensuring the vulnerable populations you serve maintain access to the care they need after the PHE.

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Claims and Encounters Analytics - MCO Analytics

Our MCO Analytics solution helps organizations decipher meaningful data insights so they can make decisions that increase productivity and improve outcomes.

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PHE Unwinding - Audit and Quality Management

Implementing an audit and quality management strategy can help you ease administrative burden and get ahead of the curve as the PHE comes to an end. Learn how we can help.

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Pre-payment Solutions - COB Data Management for Government Programs

Our COB Pre-payment Solutions offer comprehensive, CMS-certified and configurable features to advance your data management. Reduce administrative burden and proactively avoid cost.

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Pre-payment Solutions - COB On-demand Technology for Government Programs

Gainwell's COB On-demand Technology allows you to move your cost avoidance upstream. Learn how this feature pairs with our CAV Match and Delivery offering to help your organization avoid cost.

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Pre-payment Solutions - COB Self-service Portal for Government Programs

Our Self-service Portal allows clients 24/7 access to a user interface where they can submit ad-hoc verification requests, returning verified results to the user within 48 hours. Learn more.

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Pre-payment Solutions - COB Performance Analytics for Government Programs

Our Performance Analytics feature equips clients with transparency into the health of their TPL data by delivering metrics & reports, ensuring data-driven actions are taken for continuous improvement.

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Pre-payment Solutions - Cost Avoidance Match & Delivery for Government Programs

Our CAV Match & Delivery offering identifies members' existing other coverage, so healthcare organizations can proactively avoid cost, reduce administrative burden & alleviate provider abrasion.

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Pre-payment Solutions - COB Call Center Support for Government Programs

Our call center representatives can verify COB information on the spot and provide near real-time results, ensuring providers can coordinate benefits effectively and members have access to care.

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