What are the top features of best-in-class Medicaid payment technology?

Medicaid MCO claims management is complex and dynamic. The traditional approach to Medicaid payment policies and fee schedules is challenged by the increasing complexity of claims and dynamic state-by-state regulatory and payment environment.

Health plan leaders need to embrace technology solutions that enable accuracy while minimizing the lift for internal teams, especially with the variability in Medicaid. But what should you look for in your search for Medicaid Payment technology?

Top Features of Best-in-class Medicaid Payment Technology:

  1. Cloud-based Service – Enables automated, frequent Medicaid and CMS regulatory updates to eliminate IT lift
  2. Depth of content - Includes reimbursement rates and payment policy for all care settings in each state, including facility and professional claims down to the provider level
  3. Claims Payment Process Unification – Complete editing and pricing before adjudication
  4. Complete audit trail – Provides transparency that supports audits and improves provider relations

HealthEdge’s Source: Revolutionary Technology + Unique Depth of Content

With over 15 years of experience providing Medicaid and Duals support, our delivery of Medicaid pricing and fee schedules is unparalleled in the industry. As cloud-based platform, Source, is the only prospective payment integrity solution that natively brings together up-to-date regulatory data, claims pricing and editing, and real-time analytics tools into a single IT ecosystem. This transformational approach allows payers to make payments with total confidence and make business decisions with real intelligence.

The Value of a Great Vendor Partner

The ROI can be tremendous for health plans that find the right vendor partner. In one case a Source customer that processed 12+ million claims annually was able to reduce claim reworking by 40%, save approximately $6-12 per claim, and reduce IT overhead while gaining control of their workflow. The health plan improved CMS multi-state Medicaid program regulatory compliance, increased transparency on payment results, and spent less time preparing for audits, the latter of which increased staff satisfaction and retention.

Is a Traditional Approach to Medicaid Claims Payments Hurting your Health Plan?

Download our white paper Medicaid MCOs: It is time for a new claims management strategy to understand how our Payment Integrity solution, Source, is revolutionizing the way Medicaid claims are handled.

About the Author

Jared Lorinsky

Jared Lorinsky, Chief Strategy Officer, Burgess
Jared joined Burgess in 2011 and has served as the Chief Strategy Officer and SVP of Business Development since 2015. In this role, Jared ensures that every person interacting with Burgess’ products and teams gets tangible value, strategic consultation, and hands-on service. He develops business strategies and has extensive experience in the areas of product management, software design, value proposition, go to market strategy, business development and account management. Prior to joining Burgess, Jared led teams at OptumInsight, Ingenix and HSS. 

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