Solution Sheet

Precisely Data360 for Medicaid Membership and Premium Reconciliation

For healthcare payers, administering Medicaid can be a complex proposition in just a single state. But that complexity grows exponentially for payers who offer Medicaid in multiple states, because while federal regulations mandate coverage for certain populations and services, variances among state Medicaid programs abound. These disparities often hinder efforts to establish standardized Medicaid processes that can function across state lines. For this reason, payers have difficulty developing comprehensive solutions within the Medicaid space on a national or even regional scale.

But what doesn’t change, no matter the state, is the need for payers to ensure the accuracy and reliability of their Medicaid data, and safeguard process accuracy and efficiency through enterprise data governance.

The Precisely Data360 solutions provide a single, integrated solution that allows a payer to easily adapt their Medicaid program for any state regulatory and process environment. In Medicaid administration, there is a constant flow of information to and from many entities, including the payer, member, state, third-party vendors and providers. With so much data being exchanged and transformed, it is critical to have controls in place to reconcile data among systems and sources to ensure data quality. Precisely provides comprehensive data reconciliation across your Medicaid program.

Precisely membership and premium reconciliation capabilities ensure the completeness and quality of your data as it moves within and between systems across your data supply chain. It features integrated data governance to establish consistent policies and processes that ensure continued regulatory compliance and increased operational efficiency. For membership data, it is critical to identify potential issues with missing, duplicate or inaccurate data from first receipt to prevent errors from spreading to downstream systems. Membership and premium data must be in sync to ensure accuracy of monthly tracking and invoicing. And premium data must be reconciled to identify any payment discrepancies, balance monthly adjustments and prevent any delays in invoice mailing or payment processing.

Read more about how Precisely Data360 Medicaid resolution captures data from any gateway, on a user-defined schedule, performs detailed reconciliation, routes exceptions for review and generates required discrepancy reports.

Precisely Data360 for Medicaid membership and premium reconciliation