Managed Medicaid

How easily does your enrollment system handle state-specific nuances?

From eligibility rules and reporting requirements to file types and specifications, every state operates managed Medicaid enrollment differently. Internally-developed enrollment systems can address some of these nuances, but they also introduce new challenges and increase maintenance costs. By looking outside of the organization for new sources of automation, visibility and expertise, MCOs have the opportunity to achieve new levels of operational excellence.

Managed Medicaid Enrollment Infographic


Implement Inbound Data Centralization

  • Validate all files in a single location
  • Reduce errors and operational costs and improve scalability
  • Manage multiple member transactions in the same file
  • Reduce manual fallout processing
  • Enrich incoming transactions with additional data required for downstream systems

Many health plans deal with multiple state Medicaid intake points, leading to complex integration and poor visibility across the line of business. Plans must implement a single point of ingestion, back by validation tools, to improve data quality and reduce file fall out.

Deploy Intelligent Workflows

  • Enable real-time visibility into transaction fallout
  • Automate the routing of errors requiring attention
  • Resolve errors and reprocess transactions in real-time
  • Improve scalability through inherent solution flexibility
  • Decrease error rates and improve member satisfaction

With many plans operating legacy enrollment systems, tracking and resolving errors in real-time is often difficult, and labor intensive. Deploying intelligent workflows automates the identification, routing and resolution of enrollment errors.

Accelerate Upfront Discrepancy Identification

  • Streamline the Identification of missing and dis-enrolled members
  • Improve changes-only identification and processing for reduced load
  • Improve processing speed and accuracy
  • Drive program scalability
  • Reduce IT and administrative costs

Bad data at the onset of the enrollment process will cause large problems for MCOs lacking an ability to identify errors early on and allow poor quality data into downstream systems.

Improve Financial Reconciliation

  • Improve the tracking and reporting of over, under and missing payments
  • Identify discrepancies in capitation, premium or subsidy payments
  • Automate closure or reopening upon receipt of expected adjustments
  • Export and import financial details for offline review

Managed Medicaid (MCO) revenue stability hinges on accurate and timely financial reconciliation. By automatically reconciling financial transactions to each member, MCOs can mitigate financial exposure.

Enable Lifecycle Visibility

  • Deliver out-of-the box business-level view of processing performance
  • Enable transaction-level view by status with analytics
  • Deliver a single view of enrollment transactions across lines of business

Data discrepancies and file inconsistency erode processing performance. Operational efficiency and scalability rely on best-in-class enrollment management tools.