Reduce manual processes, manage plan utilization, gain financial insights & improve clinical workflows.

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 more than 100 electronic health records (EHR) or electronic visit verification (EVV) apps to aggregate data across providers. Netsmart technology allows real-time data collection in the home to track and monitor changes in condition and improve member metrics. 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 based on business rules defined by the health plan. The solution shows which claims match and which need additional information prior to payment. Data aggregation and near real-time processing provide MCOs, Medicaid agencies and private health plans with financial insights, as well as the ability to manage utilization of prior authorizations and improve outcomes.

Managed Care Organizations (MCOs)

Netsmart software for managed care organizations (MCO) helps organizations reduce fraud, waste and abuse by aggregating data across providers, so MCOs can validate claims status prior to payment . By streamlining effective clinical documentation of authorizations and users, MCOs can reduce denials by ensuring clean claims management.
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Medicaid

Netsmart software for Medicaid agencies is a web-based solution that integrates with more than 100 electronic health records (EHR) or electronic visit verification (EVV) apps to aggregate data across providers, enabling automation of paper invoices, validating eligibility, and utilization management.
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Private Insurance

Netsmart private pay insurance utilization software helps organizations can check compliance with prior authorizations, verify compliance and analyze service delivery without time-consuming manual reporting.
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