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With more than 82 million individuals expected to be eligible for Medicaid by 2026, today’s Medicaid plans are preparing for rapid growth as they deal with state budgets in crisis. To succeed, plans must maximize administrative efficiency, navigate the demands of healthcare reform and transform operations to meet continuously changing business requirements.
Our solutions support more than 60% of the nation’s managed Medicaid lives in 42 states. Our core administration solutions provide a flexible and scalable foundation for your Medicaid line of business. And when combined with our additional point solutions, they help further streamline processes and enhance the quality of care delivered to plan members.
Covering All Bases
This combination of products and services encompasses all aspects of Medicaid administration, from claims processing to medical and network management. Plan benefits include:
Increases payer efficiency, improves productivity, reduces costs and positions your business for growth.
Offers end-to-end solution that pairs modular SaaS products with industry-leading strategic consulting to connect disparate systems, standardize data and enable secure, authenticated access in real-time.
Automates pricing scenarios to provide the best value to payers, providers and patients.
Enables payer/provider collaboration to reduce costs and drive overall quality improvement.
Members may interact anytime, anywhere and receive a detailed view of their coverage information with compelling metrics, timely notifications and relevant healthcare content.
This integrated software and services healthcare BPaaS solution includes process optimization, digitization and large-scale efficiencies.
Enables physicians and other care providers to access detailed information on their patients, efficiently log claims and make templates for common claims, as well as easily create referrals and authorizations.
Manages EDI trading partners with one cost-effective, cloud-enabled technology service.
Connects care managers to members and providers while reducing costs, personalizing interventions and improving care quality.
Automate and simplify operational tasks associated with our core healthcare technology solutions, Facets and QNXT.
Extend the functionality of your core system by providing critical capabilities from enrollment through risk adjustment, to efficiently administer government solutions.
Automates transaction processing and information exchange between payer organizations and their external constituents.