Qualified Health Plan Benefit Management

Simplify Medicaid Benefit Plan Management

A single source of truth for Medicaid benefit plans with an end-to-end platform to manage plan data, documents, and systems integration while handling each state’s requirements. The proven platform facilitates Medicaid data interoperability CMS mandate and benefit plan management capabilities to Medicaid Managed Care and Medicaid Fee-For-Service plans.

  • Reduce errors, improve accuracy, and consistency.
  • Auto-generate documents, handbooks, and booklets.
  • Improve speed-to-market.
  • Improve CMS and state compliance.
  • Workflow enables collaboration across stakeholders.
  • Ensure single source of truth for multiple states’ products.

eMedicaidSync™ is a comprehensive solution designed to auto-generate documents, handbooks, and booklets, and house all Medicaid plans in a single source of truth.

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

Business friendly, easy-to-use and implement

eMedicaidSync™ is a scalable suite to house all Medicaid plans in a single source of truth for a single state or multiple state programs. The intuitive solution smoothly integrates with Core-Admin and other systems to better share data and eliminate costly manual data entry errors.

Agility and scalability for improved speed-to-market

The robust and comprehensive modular solution overcomes the interoperability challenge, allowing Medicaid Plans to start with a standard configuration and modify data to support each state’s requirements with just a few clicks. It thus improves accuracy, consistency, and speed-to-market.

The only solution developed by health plan professionals

Unlike other cross-industry solutions, eMedicaidSync™ is the only solution developed by health plan professionals for health plans. The modular solution is precise, fast, and helps improve CMS, and state compliance hassle-free.

Why eMedicaidSync™?

eMedicaidSync™ improves speed, accuracy, and cost-effectiveness of benefit plan designs. It helps you generate documents, including handbooks, booklets, and other marketing materials from a single source of truth, and helps you stay compliant with CMS and state requirements with a single click.
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Compliance Documents

Accurate, on-time up to 100%

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Speed-to-Market

Increase speed-to-market up to 70%

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Errors

Decrease errors up to 90%

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Admin Costs

Decrease admin costs up to 75%

Learn how eMedicaidSync™ can enable health plans to manage multiple states’ products in a single integrated system.

Application Modules

Our Medicaid benefit plan management solution can be molded according to your business. Select from our integrated modules that suites your business to address your pain points and maximize investments.
Create single source of truth for your plan data

Take control of your data by managing its configuration and use

Establish a single source of truth to manage multiple states' products along with Hearing, Medical, Dental, and Vision service management processes via business rule driven interface with guardrails, eliminate Excel grids, data errors, and costs, automate workflows, and routing of information between various teams using .Source
Auto-generate documents to meet regulations

Automate document generation and version management processes

Dynamically generate all product documents, including handbooks, booklets, and marketing materials to meet regulations. Enable omni-channel re-use of the language, review of formatted content within the application, share information on web portals or through print, and eliminate version issues with .Docs
Improve claims management accuracy

Simplify configuration of benefit plans and keep your claims system up-to-date

Configure your Medicaid plans 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 product configuration with .Claims
Seamlessly share information across the enterprise

Automate the integration of key benefits data and documents into essential systems

Ensure your single source of truth is integrated everywhere across the enterprise. Seamlessly integrate Medicaid plan data to any systems (Claims, CRM, portals) that need it and engage all stakeholders via integrated use-case specific workflows v/s emails using .Integrate
Access user configurable data in few clicks

Expose your user-configurable data to standard reporting tools

Ensure your dynamic pristine data is integrated with your Master Data Management investments and is available in real-time to your reporting and business intelligence tools using the relational database format and also integrate product data into other systems to better share data and eliminate costly manual data entry errors using .MDM

Frequently Asked Questions (FAQ's)

Here are the most common, 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 turn-around 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 it 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 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.

Ready to get started with eMedicaidSync™?

Work with industry-leading experts. Our team is ready to answer all your questions. Let’s make smarter health ecosystems together! Schedule a 1:1 demo with us.
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