Access a variety of
pre-populated reports that can be
customized to your needs
Configure care services, enrollment, and payments with a business process
wizard to reduce redundancies
Set prior authorization criteria to flag high-risk claims for additional review before payment
Modify contract rules, including carve-out services and FQHC/RHC capacities
Automate rate factor changes and calculations for nimble adjustments to program payouts
Core Claims and Managed Care Module
The Core Claims and Managed Care module seamlessly accommodates both Medicaid Fee-for-Service (FFS) and managed care scenarios. Built on the powerful evoBrix X™ platform, the module is designed for volume and performance demands of large-scale claims and encounters processing and payments.
Benefits:
- Combine transactional data, analytics, and intelligent workflows for clear oversight
- Create automated workflows in our purpose-built rules engine that make approval, suspension, and denial decisions in seconds
- Generate 820 and 834 HIPAA X12 mandated formats for managed care plan enrollments and benefits, as well as 834 HIPAA X12 mandated formats for remittance advice
Claims Adjudication
Acentra Health's rules-based engine provides a CMS-compliant framework to automate adjudication processes. This allows simple, no-code entry of new and updated claims processing rules created from policy, mandates, and program-specific business logic. As a result, administrators can incorporate policy changes in a timely manner to meet legislative needs. Moreover, the rules engine has the capability to shadow price encounter claims to allow for better oversight of managed care contracts.
Benefits:
- Establish checks prior and during the validation phase to actively prevent denials
- Verify member and provider eligibility to ensure approval of genuine claims
- Avoid cost recovery from duplicate claims and service/benefit conflicts
- Contains thousands of pre-configured business rules, pricing rules, industry standard edits, and audits
Core Claims and Managed Care Module
Core Claims and Managed Care Module
The Core Claims and Managed Care module seamlessly accommodates both Medicaid Fee-for-Service (FFS) and managed care scenarios. Built on the powerful evoBrix X™ platform, the module is designed for volume and performance demands of large-scale claims and encounters processing and payments.
Benefits:
- Combine transactional data, analytics, and intelligent workflows for clear oversight
- Create automated workflows in our purpose-built rules engine that make approval, suspension, and denial decisions in seconds
- Generate 820 and 834 HIPAA X12 mandated formats for managed care plan enrollments and benefits, as well as 834 HIPAA X12 mandated formats for remittance advice
Claims Adjudication
Claims Adjudication
Acentra Health's rules-based engine provides a CMS-compliant framework to automate adjudication processes. This allows simple, no-code entry of new and updated claims processing rules created from policy, mandates, and program-specific business logic. As a result, administrators can incorporate policy changes in a timely manner to meet legislative needs. Moreover, the rules engine has the capability to shadow price encounter claims to allow for better oversight of managed care contracts.
Benefits:
- Establish checks prior and during the validation phase to actively prevent denials
- Verify member and provider eligibility to ensure approval of genuine claims
- Avoid cost recovery from duplicate claims and service/benefit conflicts
- Contains thousands of pre-configured business rules, pricing rules, industry standard edits, and audits
Managed Care Administration
and Encounters Claims Processing
Acentra Health's evoBrix X™ technology performs accurate, rapid encounter claims processing. Our team of technology professionals design our managed care program administration solutions to adhere to current requirements and your future needs. Your administrators can view impacts to enrollments and capitation payments as potential updates occur to programs, contracts, and rates.
Alleviate administrative burden: enable self-service, reduce paper, and improve revenue cycle times
Lower development and maintenance costs with low-code to no-code configuration management
Create service-based enhancement payment configurations to improve provider relationships
Give eligible members enrollment choices and re-assignment options to increase overall satisfaction
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CASE STUDIES
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