Simplify Medicaid Plan Management

A configuration of the Benefits1™ platform for end-to-end management of Medicaid Plans
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medicaid benefit plan management, medicaid fee for service, medicaid management information system, medicaid claims processing, medicaid product configuration solution, Benefits1™.Medicaid (formerly eMedicaidSync™)

Fuel Your Growth in the Medicaid Market

Leverage Benefits1™.Medicaid to enable a connected benefits journey for the Medicaid market

Manage Products in One Place

Create accurate Medicaid Managed Care (MMC) and Medicaid Fee-For-Service (MFFS) benefit plans from a single source of truth

Robust Collaboration

Enable cross-functional teams and business processes by activating an out-of-the-box workflow engine across unlimited users

Errata-Free Compliance

Achieve 100% compliance with Medicaid materials including handbooks and booklets by leveraging a 508-compliant document automation engine

Power your connected benefits journey with integrations

Extend the capabilities of Benefits1™.Medicaid with a host of integrations to achieve end-to-end lifecycle management of your Medicaid Health Plans
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.Actuary

Accelerate actuarial inputs to design changes and portfolio ideation

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.IntegrationHub

Use API and events to communicate data in a model that is easily consumable by target systems

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.SuperUser.Studios

Empower superusers to maintain design, rules, and workflow configurations while also establishing governance

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.DataServices

Use a relational database to drive reports and analytics on the source of truth data or communicate it in a model that is easily consumable by target systems

.AI

Leverage the power of Generative AI to incorporate periodic code set changes published by the CMS into Benefits1™ and provide context-aware help from the product assistant

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Service1™

Deliver accurate and complete answers to members, providers, employer groups, and brokers/agents for benefit inquiries

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Claims1™

Enable automated claims configuration, code set level configuration of benefits, and testing to support claims adjudication

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Experience1™

Automate dynamic content generation and stream accurate, compliant, and consistent benefits data across the enterprise

Simplify Healthcare is positioned in the Leaders Category in the 2023 IDC MarketScape for U.S. health plan product/plan benefit configuration solutions.

What Our Customers Say

Frequently Asked Questions (FAQs)

Here is what our customers usually ask us

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

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 a 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

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

How does Benefits1™.Medicaid, an automated Medicaid benefit plan management solution, fix issues seen in legacy processes?

Benefits1™.Medicaid 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 Benefits1™.Medicaid 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 Benefits1™.Medicaid’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%

Can Benefits1™.Medicaid help with CMS and State regulation compliance?

Yes, it absolutely can. Benefits1™.Medicaid is the only solution developed by Health Plan professionals keeping in mind the specific requirements of Health Plans. With Benefits1™.Medicaid, 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