Medicaid Utilization Management Solution Simplifies Monitoring Providers’ Compliance With State Regulations

Medicaid

Netsmart Medicaid software helps organizations reduce fraud, waste and abuse. The web-based solution integrates with more than 100 electronic health records (EHR) and electronic visit verification (EVV) mobile applications to aggregate data across providers. As a result, Medicaid organizations can monitor providers’ compliance with state regulations, check compliance with prior authorizations and analyze service delivery without time-consuming manual reporting.

Netsmart Medicaid claims adjudication technology pre-screens, scrubs and provides all claims submissions in a standard format, enabling effective submission for timely billing. The solution shows which claims match and which need additional information prior to payment. Data aggregation and near real-time processing provide Medicaid organizations with financial insights and the ability to manage utilization of prior authorizations and improve outcomes, automating reimbursement to organizations.

 

AT A GLANCE

Simplify monitoring compliance with state regulations, prior authorizations and claims submissions:

Features
  • Web-based solution integrates with more than 100 EHRs and EVV mobile applications
  • Supports verification of regulatory compliance
  • Automates prior authorizations
  • Adjudicates, scrubs and provides claims in a standard format
Benefits
  • Reduces manual reporting
  • Shows which claims match and which need additional information prior to payment
  • Allows Medicaid organizations to manage prior authorizations and improve outcomes

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