Medicaid is the single largest source of health coverage in the U.S., and millions of uninsured individuals are becoming newly eligible for Medicaid under the Affordable Care Act (ACA). The Centers for Medicare & Medicaid Services (CMS) has offered states strategies to facilitate processing applications for large numbers of people who become newly eligible for Medicaid. All of the approaches are intended to promote enrollment and retention, while minimizing administrative burdens for states.
GHG will ensure your members gain the quality customer service that they deserve by developing sound, sustainable operations (including: call center, eligibility/enrollment, reconciliation, provider appeals, provider relations, grievances, claims, dual payment status, credentialing, risk adjustment operations among others) with processes that comply with performance standards. We will also assess current state of systems in order to apply industry best practices and provide technology solutions to yield the best, most effective and efficient results.
Additionally, GHG will work with you to manage the administrative and clinical challenges of expansion including adjusting to the higher volume of Medicaid enrollees, developing risk/cost-sharing arrangements that can help build your provider network, gaining and retaining providers willing and able to provide quality care, and utilizing non-clinical social services to address barriers to health, among other operational efficiencies.