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.

Video
Real-World Examples: Elderplan

Craig Azoff, Vice President of Health Plan Information Services at Elderplan, Inc., a New York based health plan with Medicare, Medicaid and Dual populations, talks about the key ingredients for a successful implementation and beyond.

HealthEdge’s HealthRules product suite enables 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
Elderplan's Success with HealthRules
92.5%
Auto-Adjudication Rate
0
Claims in Backlog >15 Days Old
1.7M
Claims Processed in 2017
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.

Medicaid businesses strive to achieve maximum efficiency while remaining compliant with each state’s specific regulations. These companies recognize the importance of having the latest technology platform. HealthEdge Medicaid customers achieve greater levels of operational efficiency, lower costs, and deliver enhanced levels of transparency and customer service while providing  compliant and high-quality care with the HealthRules product suite.