Medicaid Management

Medicaid is complex, and it's constantly changing. We’ve been helping agencies like yours wrangle it for five decades — always looking and thinking ahead with innovative solutions, insightful approaches to improving how you manage your program and creating healthier outcomes.

Our CMS-certified Medicaid Management solutions are modular, intelligent and cloud-based, and they cover all your management needs. Claims and encounters? Check. Provider Solutions? Check. Managed care, EDI clearinghouse, prior authorization, value-based care? Check, check, check and check. And much, much more, but you get the idea.

Don’t need all that? No problem. You can take the whole bundle or just the modules you need. We’ll set things up exactly the way you want.

How We Can Help

Our people have deep knowledge, and our systems are smart and evolved. We can help to accelerate claims processing, support value-based care and control escalating costs with our comprehensive and integrated suite of solutions that orchestrates workflow and task management.

Core Medicaid Solutions

Claims, Encounters and Financials

We can keep your claims, encounters and financials straight in the face of shifting healthcare needs, ever-increasing enrollment and federal policy changes. We provide enterprise-wide COTS modularity to support state-specific Medicaid needs and other health and human services programs. Enjoy the highest-level security, integrity and output to diverse trading partners and providers while meeting federal requirements.

EDI Clearinghouse

Simplify provider Medicaid billing with comprehensive validation rules for managed care and fee-for-service transactions. Ensure your encounter data is compliant through a single point of submission.

Provider Solutions

Wrangling providers is a time-consuming endeavor that can be full of inefficient and repetitive manual processes. We can ease your burden. Our Provider Service and Provider Credentialing tools are a flexible, cloud-based SaaS platform based on COTS software. They are aligned with industry standards to assist providers from initial enrollment through final determination letter and supports providers’ participation in fee-for-service and other programs, including enrollment with MCOs.

Managed Care

We know what you’re looking for as a state agency trying to manage numerous MCOs more proactively — to contain costs, keep track of enrollment and mind the details. Our Managed Care solution helps you track members’ MCO enrollment as they transition across different plans, improve capitation payment forecasting and payment processing. It’s a seamless, end-to-end administrative solution for your Managed Care Program.

Prior Authorization Rules Engine

Experience the time-saving and satisfaction-enhancing benefits of our Prior Authorization Rules Engine. Automate and expedite authorizations for your state with configurable rules and workflows designed to improve member and provider satisfaction.

Value-Based Care

Helping improve the health of your community is an important mission. We can help you reduce costs, manage claims data and provider payments and improve patients’ health outcomes. Our value-based care analytics, consultation and administration solutions are there to support you and those you serve.

Reduce Costs, Improve Health Outcomes