Customized Analytic Tools

Center for Health Care Financing experts, who are well-versed in the intricacies of Medicaid, manage and support a multidimensional data environment that serves as a development platform for new Medicaid finance business intelligence solutions.

Case tracking

The Center has helped design breakthrough software that delivers agile, flexible, and affordable case management. The customized case tracking solution helps to integrate systems across recovery efforts — casualty and estate — as well as Medicaid Management Information Systems (MMIS). It also reduces the daunting amount of paper submissions to a paperless system. This software has significantly increased customer satisfaction by decreasing claim response time and paper files. More importantly, the streamlined technology has led to a 40 percent reduction in business performance costs and reduced maintenance costs.

Random moment time studies

We have developed an advanced Web-enabled application that lets Medicaid providers complete time studies, document the delivery of health–related services, and submit claims electronically to facilitate school-based claiming for Medicaid-eligible students with special needs.

Eligibility and payment determinations

Experts from the Center can assist state governments in implementing modern eligibility and payment determination systems.  Such systems can provide states with significant opportunities for revenue growth and cost containment For example, the Center developed and deployed a new State Supplemental Payment (SSP) System, allowing staff to administer this state benefit program in-house, on behalf of the Commonwealth of Massachusetts, generating a significant annual savings over current costs.

Medicaid Administrative Claims System (MACS)

MACS is an online web application that automates the process of submitting to the federal government the qualified payroll and non-payroll Medicaid related administrative expenses of an organization that meet the criteria for reimbursement under Federal Financial Participation rules. The system vastly reduces the time needed to produce a Medicaid Administrative Claim, improves the accuracy of the claim, and eases the burden of responding to audit requests about the claim.

Third Party Appeals (TPA) Automation

The Third Party Appeals (TPA) automation system is a web-enabled application that allows analysts to identify and review home health claims paid by Medicaid that require a Medicare determination of coverage for dual eligibles.  It contains information on providers of medical services, beneficiaries, cases, and claims associated with each case. The TPA system allows analysts to record and track dates and statuses of the case episodes throughout the lifecycle of the appeals process.