Applying digital solutions to healthcare delivery questions.
Capitalize on program expansion
- Medicare and Medicaid expansion—Assist customers with new business acquisition and expansion with scalable options.
- Medicare Advantage enrollment and financial reconciliation—Ensure accuracy through reconciliation of enrollment and CMS payment reports.
- Advisory and implementation services—
- Integrated care for Dual Eligibles market—Enable integrated dual demonstrations and reduce time to market with our end-to-end products, implementation services and repeatable frameworks.
- Long-term care and long-term services and supports (LTC & LTSS)—Enable successful implementation of LTC/MLTSS programs by managed care organizations (MCOs).
- My government health plan—A multi service “stack” solution for Medicare Advantage plans.
Connect with digital consumers
- Member retention and recapture—A solution to assure member retention and recapture strategies using healthEngage
- Member outreach and care coordination
- Provider engagement strategies and credentialing
- Population health management—A comprehensive PHM solution to improve care and health outcomes for chronic conditions, especially for duals
- Digital works and analytics
- HEDIS reporting for Medicare/Medicaid—An NCQA Certified HEDIS Solution that helps you plan, monitor, intervene and improve HEDIS scores and quality of care
Launch digital-ready processes
- Enrollment administration—Accurate MA/Part D enrollment, including data collection, maintenance and submission to CMS
- Financial reconciliation—Automated reconciliation of CMS Medicare payments
- Risk adjustment and revenue optimization—Helps identify and predict gaps in HCC coding to plug revenue leakage
- Encounters and PDE management—Manage, audit and attest the completeness and accuracy of Encounter and PDE data
- Pharmacy oversight and PDE data management—Automates the PDE submission process and workflow with CMS and PBM
- MSP validation and premium restoration
- Industry & platform solutions—Enrollment, billing, claims, customer service, care management and credentialing
Offer superior care, complete compliance
- Star rating performance enhancement—Earn higher incentive payments and attract more members with integrated consulting, robust analytics, automated campaigns and nurse based intervention.
- Compliance oversight and management—Ensure audit readiness and compliance with CMS requirements.
- Broker/agent management
- Appeals and grievances (A&G)
- Medicaid regulation—Perform impact assessment and remediation.
Scale up for performance
Our products and platforms enable efficient claims processing, automated enrollment, encounter management, quality reporting and member-centric care management.
Take the first step
Serving customers by looking forward as well as back is a big promise, but the power of today’s new digital capabilities is vast and growing.
Let’s talk about how digital can work for your business.