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Stay Compliant With Regulatory Changes


Government programs have unique requirements that mandate that health plans stay current with.

Expensive sanctions or even total shutdowns can result from non-compliance. It is imperative that technology systems not only support but fully enable rapid and reliable changes in response to changing regulations, whether they originate from CMS or state-regulated Medicaid programs. With today’s uncertainty regarding overall healthcare reform, the ability to modify underlying rules, produce auditable information and deliver reports is mandatory. All this while enabling the highest quality of care at the lowest price for the best member experience. And health plans must react quickly, always staying within compliance time windows.

Real-World Examples: UMMS Health Plans

Jose Vazquez, Vice President, Solutions at University of Maryland Medical Systems Health Plan, talks about the growth of the plan from start-up to present day, and the need for transformational technology that helped UMMS succeed. UMMS serves Medicaid and Medicare members who rely on the health plan and their provider network for critical services.

HealthEdge customers with Medicare, Medicaid and Duals memberships rely on HealthRules solutions to remain compliant in the face of ever-changing regulations. HealthRules Payor provides the flexibility to make necessary system changes and HealthRules CareManager allows health plans to achieve the highest quality ratings while staying on top of changing regulations. The result is attainment of the highest revenue, with high ratings not only from the government, but from members as well.