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


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.



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

  • 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
  • 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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