Tag Archives: Managed Medicaid

Modernizing Medicaid: Mega-Reg implications health plans should know

Payers manage a multitude of responsibilities as it relates to their Medicaid membership. From regulatory adherence, and payment integrity optimization to enrollment management, the current, and sometimes, complex canvas of Medicaid oversight is now growing.   The Department of Health and Human Services (HHS) issued a new ruling earlier this year with the intention to […]
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10 tips for working with MCOs to advance Medicaid program integrity

Have you turned to managed care organizations (MCOs) to reduce Medicaid costs and improve patient care? If so, you probably know how difficult it is to know for sure whether your MCOs are doing all they can to reduce fraud, waste and abuse. In May 2015, CMS proposed a new rule that MCOs strengthen their […]
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Rethinking your MMIS: Change is good

“He who hesitates is lost.” “The early bird gets the worm.” And for those of you old enough to remember a popular Alka-Seltzer® commercial, “Try it, you’ll like it.” No matter how you say it, popular wisdom suggests that getting in on the ground floor of change is good. And nothing begs for change more […]
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Provider engagement has a major impact on quality, costs and outcomes

Health care market dynamics now impose risk adjustment and quality standards on financial performance across all market segments — Medicare Advantage, Managed Medicaid and commercial plans. To balance risks, improve quality and decrease costs, plans must move beyond retrospective claims analysis and basic assessments. Improving plan performance also hinges on provider engagement. A changing market […]
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