Protecting Enrollees at a Reasonable Cost
Payment Integrity and case management are key components of a Comprehensive Medicaid Integrity Plan (CMIP). Your Medicaid Information Technology Architecture (MITA) needs open, scalable, modularized and best in class analytic solutions to drive integrity.
- Pricing leveraging UCR and all 16 Medicare Prospective Payment Systems to facilitate price negotiations and integrity checks
- Advanced Medicare, Commercial and Medicaid analytics logic to assess payment compliance at a granular level
- FWA analytics and reporting at the enrollee and provider levels
- Case management system extensions to pass potential aberrations detected into a functional workflow system in your SIU
- Special investigation business partnerships to facilitate rounding out your CMIP if needed