Case Study: Medicaid & Duals
A top-15 insurance company with over 5 million members aimed to expand its government business, streamline operations, and explore new models.
Optimizing Medicaid Duals Payment Integrity
A top-15 insurance company with over 5 million members aimed to expand its government business, streamline operations, and explore new models. To achieve scalable success, they required a fully automated claims reimbursement process. Partnering with operational and IT leaders, we implemented a multi-stage rollout of our SaaS platform, encompassing:
- Existing Medicare Advantage and commercial use cases
- Expanded federal services including dual-eligible demonstration programs and Medicaid programs in California and Arizona
Notably, the AHCCCS Medicaid solution outperformed Arizona's state system, becoming the client's source of truth. Our engagement delivered significant savings and operational improvements:
- Reduction of approximately 800,000 erroneous claims per year leading to $4M in annual savings
- Automation saving $6-12 per claim
- Reduced IT overhead saving $350-500K annually
- Proven success across Medicare Advantage payment integrity, multi-state Medicaid implementation, and dual-eligible programs
- A single automated claims process for all lines of business resulting in millions of auto-priced claims per month
Our 20+ year collaboration has enabled hundreds of millions in savings across Operations and Finance, reinforcing our commitment to optimizing Medicaid Duals Payment Integrity.
