Dual Eligibles
Although beneficiaries who qualify for both Medicare and Medicaid benefits are a small percentage of your health plan’s member base, they consume a disproportionately high percentage of program costs – and coordinating payments between the two programs can be a challenge.
HealthEdge® dual eligibles solutions can help your health plans provide high-quality care to Dual-Eligibles members at every stage and deliver positive health outcomes while keeping costs low. Our integrated dual eligibles solution suite enhances claims processing with payment integrity and feeds data to an end-to-end care management solution. Together, these solutions enable regulatory compliance, lower administrative costs, higher-quality care, and improved patient outcomes.
How HealthEdge
Can Help
HealthRules® Payer
Our HealthRules product suite improves your efficiency while accelerating throughput and reducing administrative costs through automation. At the same time, it enables you to bring new offerings to market and to understand the dental health of your members through analytics.
Source
Medicare undergoes major quarterly updates, policy adjustments and retroactive changes with fee schedules requiring constant maintenance, research and manual updates. Source automates these processes with cloud-based delivery and gives you the flexibility to customize contracts and focus on innovation, growth and customer satisfaction.
GuidingCare®
With GuidingCare®, you can increase collaboration among all stakeholders for maximum coordination and member engagement, leading to improved STAR ratings, better health outcomes and increased member satisfaction.
Wellframe
Gain insights between clinical encounters and provide more consistent support to your Dual Eligibles beneficiaries. Wellframe Digital Care Management extends the reach of your staff to engage more fully with your high-risk members.
Source
Medicare undergoes major quarterly updates, policy adjustments and retroactive changes with fee schedules requiring constant maintenance, research and manual updates. Source automates these processes with cloud-based delivery and gives you the flexibility to customize contracts and focus on innovation, growth and customer satisfaction.
GuidingCare®
With GuidingCare®, you can increase collaboration among all stakeholders for maximum coordination and member engagement, leading to improved STAR ratings, better health outcomes and increased member satisfaction.
Wellframe
Gain insights between clinical encounters and provide more consistent support to your Dual Eligibles beneficiaries. Wellframe Digital Care Management extends the reach of your staff to engage more fully with your high-risk members.
HealthRules® Payer
Our HealthRules product suite improves your efficiency while accelerating throughput and reducing administrative costs through automation. At the same time, it enables you to bring new offerings to market and to understand the dental health of your members through analytics.