Tracks and audits quality of care management, including Never Events, for Commercial and Medicaid cases to determine the quality of care being delivered by the health plan.
Customer Service teams can document and track the dissemination of ID cards, membership or collateral to health plan members. The module can also communicate with the print vendor to close the loop.
Utilization Manager is an Organization Determination and Authorization solution that enables referrals to be generated and managed for Part C – Medical inpatient, outpatient and physician services that require authorization.
Enrollment Manager is the intake enrollment application process in which an enrollee or applicant is signed up with the health insurance company and coverage is made effective. The eligibility product is the system of record for the health plan enrollment data including history and segments.
The system supports the process in which the plan manages the member including the enrollment records, enrollment data and file transmissions, BEQ, MMR, TRR, workflow, correspondence, etc. thru print and fulfillment. This product is for Medicare or MAPD plans. Future plans may include a version for other lines of business.
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