Medicaid Managed Care Compliance

Maximizing services that meet regulatory and payment pressures

Providing much-needed services to a highly divergent population while staying within the boundaries of restricted payments and eligibility requirements, are concerns for Medicaid plan sponsors. Many are caught in a balancing act between providing high quality clinical support and meeting varying state requirements, HEDIS and Quality measures, all under severe financial constraints.

How Visante can help

Visante’s experts have COO and CPO experience in multi-state Medicaid plans to your organization, and we apply our industry experience and best practices to your specific needs. In concert with our business partners like Change Healthcare Consulting, we provide services that cover everything from high level strategic planning to detailed assessments and recommendations for improved operational efficiencies and compliance.

Visante’s Plan Support Services include:

  • Operations assessment and recommendation for improved performance from contract management through eligibility issues to accurate and timely claims adjudication.
  • Creation of a medical pharmacy structure to maximize the integration between the pharmacy and medical benefit improving outcomes.
  • Advise and assist with programs to strengthen critical points in care, such as discharge and high cost specialized pharmacy programs.
  • Readiness reviews and preparation for collaboration with state government programs.
  • A review of formulary administration to ensure the quality and efficacy of medicines meet state Preferred Drug Lists (PDLs) and formulary rules. We also provide reporting assistance to meet requirements for accurate and timely reporting to overseeing state(s).
  • Assistance with maximizing HEDIS and quality measures.

Looking for more information? Check out these links to helpful articles and information from our experts:

General information