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.