Netsmart health plan software helps managed care organizations (MCOs ), Medicaid agencies and private health plans reduce waste, fraud and abuse. Web-based solutions integrate with any electronic health record (EHR) or electronic visit verification (EVV) app to aggregate data across providers. As a result, MCOs, Medicaid agencies and private health plans can check compliance with prior authorizations, verify regulatory compliance and analyze service delivery without time-consuming manual reporting.
Netsmart health plan claims adjudication technology pre-screens, scrubs and provides all claims submissions in a standard format, speeding payments to providers. Data aggregation and near real-time processing provide MCOs, Medicaid agencies band private health plans with financial insights, as well as the ability to optimize prior authorizations based on outcomes.