Reduce manual processes, manage plan utilization and gain financial insights with managed care organization (MCO) software

By Health Plans

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.

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