Realize operational excellence and meet compliance requirements of Medicaid benefit plans

Industry’s first end-to-end Medicaid Managed Care and Medicaid Fee-For-Service plan management solution to manage Hearing, Medical, Dental, and Vision service management processes and multiple states’ products in a single integrated system.

Industry Challenge 

  • No single source of truth for Medicaid benefit data 
  • Product configuration driven off Excel grids 
  • Duplicate data entry into several systems 
  • Manual processes 

Impact 

  • Errors and inconsistencies in Medicaid benefit data 
  • Decreased speed to market 

Our Solution 

  • Creates a single source of truth for benefits data 
  • Eliminate errors and inconsistencies in data across systems 
  • Allows payers to seamlessly manage multiple states’ products in a single integrated system. 

Industry Challenge 

  • Teams operating in silos 
  • Repetitive efforts 
  • Multiple rounds of back and forth between teams 

Impact 

  • Operational roadblocks 
  • Slowed business growth 

Our Solution 

  • Out-of-the-box standard workflows for Medicaid plans 
  • Improved collaboration across all stakeholders 
  • Improved operational efficiency and output 

Industry Challenge 

  • Dependency on point solutions to solve specific problems 
  • Evolving business needs, market dynamics, and constantly changing compliance requirements 

Impact 

  • High cost of operations 
  • Process inefficiencies across the organization 

Our Solution 

  • Out-of-the-box standard workflows for Medicaid plans 
  • Improved collaboration across all stakeholders 
  • Improved operational efficiency and output 

Why eMedicaidSync ?

eMedicaidSync™ improves speed, accuracy, and cost-effectiveness of benefit plan designs. Its modular nature ensures scalability to continually fulfill the needs of payers as their business grows.
Compliant Documents
100%
Speed to Market
70%
Errors
90%
Admin Costs
75%

Choose an end-to-end solution or select any module to solve specific pain points

Our benefits plan management solution can be molded according to your business. Select from our integrated modules that suit your business to address pain points and maximize investments.

Integration of other solutions with eMedicaidSync™ ecosystem

eClaimsEngine™ – Our claims configuration solution, integrates as a component of eMedicaidSync™ to configure your Medicaid benefit product data at one place with intelligent decision support, eliminate repetitive data entry into Core-Admin and other systems, keep your claims system up-to-date, and automate the maintenance of your benefit configuration.

Frequently Asked Questions (FAQs)

Here are the answers to the most frequently asked questions about implementing end-to-end Medicaid benefit plan management solution and partnering with Simplify Healthcare.

1. What is Medicaid benefit plan management?



Medicaid benefit plans solution encompasses the entire Medicaid benefit plan management process, including configuring and updating the plans, generating documents, and integrating that information across the organization while maintaining CMS and state compliance.

2. What are the challenges with traditional Medicaid benefit plan build processes?



The traditional, manual Medicaid benefit plan management processes, based on benefits grids, are prone to errors. These processes involve back and forth that ultimately result in version control issues and erroneous information being manually entered into Core-Admin and other systems. With traditional processes, it usually takes weeks to configure a market-ready Medicaid benefit plan. Moreover, managing Medicaid benefit plans with spreadsheets and communicating via emails means last-minute changes, which often pose challenges for already overburdened product teams. Some of the critical challenges with legacy benefit plan configuration processes are:

  • Data-driven Excel grids with repetitive data entry into Core-Admin and other systems leads to a lack of version control with data redundancy.
  • Lack of central repository to manage Medical, Dental, Hearing, Vision services, and multiple states’ product requirements.
  • Handling CMS and state compliance become a challenge.
  • Lack of data integration and workflow collaboration across other systems and stakeholders.
  • There is no single source of truth methodology to update/manage all product data, including handbooks, booklets, and other marketing materials.
  • Disparate legacy Medicaid plan management processes result in low data accuracy, high risk of errors, and data redundancy.
  • Processes were labor-intensive, prone to human error, and improving speed to market was a massive challenge.

3. What are the benefits of automating your Medicaid plan management processes?



Here are some of the key benefits of automating your Medicaid benefit plan management processes:

  • Reduce turnaround time and improve speed to market.
  • Reduce errors, improve data accuracy, and consistency.
  • Create a single source of truth for Hearing, Medical, Dental, and Vision services and manage single or multiple states’ product requirements in a single integrated system.
  • Promote data reusability and reduce the risk of errors due to manual processes.
  • Use the market-leading single source of truth approach as a central repository to make changes to your plan data. Apply changes in one location and have them reflect in all aspects of your plan.
  • Easily update Medicaid plan data and auto-generate documents, handbooks, and booklets in just a few clicks.
  • Automate your CMS and State regulation compliance processes with a more robust quality audit and easy mandate update incorporation.

4. How does eMedicaidSync™, an automated Medicaid benefit plan management solution, fix issues seen in legacy processes?



eMedicaidSync™ provides a single source of truth to Medicaid Managed Care plans and Medicaid Fee-For-Service programs to manage plan data, documents, systems integration while handling each state’s requirements. It utilizes an advanced single source of truth methodology that acts as a central repository for the Medicaid benefit plan data making it accessible across the enterprise. When changes are applied to the master template, it reflects the changes across all sections. An automated solution means stakeholders do not have to communicate via emails and spreadsheets. There is better version control, and it’s easier to implement last-minute changes.

Here are some ways eMedicaidSync™ solves the issues with legacy processes:

  • A single source of truth solution to manage Medicaid benefit plans data, documents, systems integration while handling each state’s requirements.
  • Efficiently manage last-minute changes with eMedicaidSync™’s workflow management, enabling collaboration across all stakeholders, and data changes are seamlessly applied across the enterprise.
  • A proven platform with benefit plan management capabilities for Medicaid Managed Care plans and Medicaid Fee-For-Service programs.
  • Health plans can now easily manage CMS, state mandate updates, auto-generate documents, handbooks, and booklets with just a few clicks.
  • Reduce turnaround time to fewer calendar days and thus significantly improve your speed to market by up to 70%.
  • Ensure a single source of truth for multiple states’ products and quickly decrease admin costs by up to 75%.

5. Can eMedicaidSync™ help with CMS and state regulation compliance?



Yes, it absolutely can. eMedicaidSync™ is the only solution developed by health plan professionals keeping in mind the specific requirements of health plans. With eMedicaidSync™, you would be able to implement CMS and state regulations, update, and be ready to roll out the product in just a few days. You would also be able to auto-generate Medicaid benefit plan-related communication documents like handbooks, booklets, and other marketing materials with only a few clicks.