Succeed in a regulated market

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.

• Enrollment Administration Manager
• Claims Data Manager
• Encounter Data Manager
• RX Reconciliation Manager
• HCC Risk Adjustment Manager
• Financial Reconciliation Manager
• Risk Score Manager
• PDE Data Manager