The old saying goes, “If you’ve seen one state Medicaid program, you’ve seen one state Medicaid program.” The increasingly complex and dynamic state-by-state regulatory and payment environment across Medicaid has become nearly impossible for Medicaid-managed care plans to keep up with the pace of change and scale their Medicaid lines of business.
With varying fee schedules that get updated at different intervals and policy updates that can change on a dime, most health plans have accepted the fact that much of the work required to keep up with Medicaid has to be done manually.
In fact, in a July 2022 HealthEdge survey of more than 400 health plan leaders serving Medicaid populations, 91% reported that they depend on human resources to manually perform this work on a monthly or quarterly basis.
During normal times, keeping up with these complexities can be challenging and expensive, but also rewarding for those organizations who get it right.
However, we are not living in normal times.
The healthcare industry has been hit hardest by “the great resignation” as the survey results show that 89% of health plans are experiencing clinical and administrative shortages.
The combination of severe workforce shortages and intense reliance on manual resources to maintain accurate and timely Medicaid payment data has introduced new risks for many health plans. More specifically, survey respondents claimed their top five challenges to be:
- Staying compliant with changing reimbursement policies, 75%
- Installing updates to the fee schedule in a timely manner, 62%
- Having transparency within your system to response to audits, 54%
- Keeping up with changing fee schedules, 50%
- Too many manual processes, 33%
To date, there has been very little innovation and automation in this space due to the unique, state-specific schedules and policies. But that is changing with Source, the prospective payment integrity solution from HealthEdge.
Source dramatically improves efficiencies when it comes to Medicaid claims processing by automating the delivery of in-depth, state-specific fee schedules and payment policies across a wide range of facility and professional provider types.
The Source team has an aggressive plan to leverage their renown Medicare expertise and content development and apply it to state Medicaid programs. And they’re moving fast, already delivering schedules and policies every two weeks for many states. Their goal is to cover 35 states over the next few years. The Source solution for Medicaid programs also includes a comprehensive range of provider types such as hospital inpatient, hospital outpatient (HOPD), professional services, suppliers, home health agencies, hospice organizations, nursing facilities, dialysis centers, and ambulatory surgery centers.
To learn more about how our focus on automating state Medicaid updates can help your organization, talk to a Source specialist at www.healthedge.com/products-services/burgess-source.