This leading healthcare company focuses on providing government-sponsored managed care services through Medicaid and Medicare Plans to families, children, seniors and individuals with complex medical needs. This project objective was to build a case management tool that allows their users to analyze and update/correct the fallout cases that are being created out of withheld and state reject encounters coming from the client’s Encounters Processing System (EPS). The EWFM will batch these fallout cases based on user defined grouping logic into individual batch cases based on user batching criteria. Once the batches are created, the system will assign batches to the user based on the priority score. User can analyze the batches and make necessary updates to correct these encounters.
Maantic was involved in the following: