Our Solutions

Medicaid

Health plans serving Medicaid members must provide high-quality care and keep costs under control while ensuring compliance with changing state regulations.

The combination of HealthRules® Payor, Burgess Source®, and GuidingCare® is the first-of-its-kind integrated solution suite featuring three next-generation, cloud-based applications that can help Medicare and Medicare Advantage businesses stay ahead in today's competitive market.

With HealthRules Payor, health plans with a Medicaid line of business achieve maximum efficiency while remaining compliant as new state-specific regulations emerge. HealthRules Payor automates critical business processes, lowers administrative costs, and delivers enhanced levels of transparency and customer service.

Case Study
Lower Administrative Costs & Maximize Operational Efficiency

Headquartered in Brooklyn, New York, Elderplan is a well-established, not-for-profit health plan that leverages HealthRules Payor to maximize their operational efficiency, control administrative costs and embrace an evolving business model.  Elderplan serves high-risk populations and promotes the delivery of high-quality care for improved patient outcomes while enjoying the benefits of next-generation technology.

Case Study with Elderplan Logo

Medicaid plans require technology that can streamline their businesses, handle complex situations, match negotiated terms exactly, and use custom payment schedules. Cloud-based delivery of up-to-date Medicaid policies and fee schedules lowers administrative costs, increases operational efficiency, and mitigates risk from a compliance standpoint.

Data Sheet
Burgess Source Pricing & Editing Advantages

Burgess Source's unique capabilities offer health plans serving Medicaid members the opportunity to modernize claims processing in an agile, streamlined ecosystem. Benefits include improved accuracy and compliance with reductions in workflow and software maintenance, claims rework, and recovery spending. Download the data sheet to learn more about the unique advantages of Burgess Source.

One in four Medicaid members across 40+ states are managed on GuidingCare. Supporting state-sponsored programs serving the most vulnerable and high-risk populations, GuidingCare was the first care management platform to integrate with leading social services search-and-referral platforms to manage SDOH. GuidingCare delivers value in the context of state regulations and innovates in partnership with government programs. 

Working together, HealthRules, Burgess Source, and GuidingCare enable health plans serving Medicaid markets to improve operations and outcomes, including:

  • Enroll and reconcile members efficiently and accurately
  • Lower administrative costs significantly by automating critical  business processes
  • Identify and provide care to high-risk populations and members with high utilization
  • Achieve and maintain regulatory compliance as new rules emerge in each state
  • Track and report on critical quality and compliance measures
  • Deliver transparency of information for increased member engagement and superior customer experience
  • Leverage key data sources with seamless integration
  • Coordinate individuals' healthcare and support services effectively