Report more accurate health status
Accurately documenting the health status of Medicaid populations is important to your plan’s risk and quality programs. States differ in their individual Medicaid regulations, reimbursements and penalties. It can be a challenge for health plans to stay current with ongoing changes.
Our comprehensive risk and quality services
Provider engagement
In addition to the challenges in keeping up with state regulations, plans can also face challenges engaging with providers. We can help you determine which provider engagement strategy may be most effective for your network and can empower providers with timely, actionable data at the point of care.
Member engagement
Engagement with Medicaid members is critical to identifying health conditions and closing gaps in care. We enable you to precisely target the right members, understand how to support them and efficiently deliver programs based on their needs.
Encounter submissions
Your organization’s data, resources and needs are unique. We combine consultative services and technology to provide transparency and workflow tools via a self-service portal. We will intake encounter data, transform it and submit it to State Managed Medicaid as required.
Adjusted claims
Medicaid organizations are required to submit complete and accurate claims data to satisfy state agency requirements. To report a more complete picture of member health, Optum helps coordinate a provider review and claim correction for unreported conditions found in medical records.
Key benefits
Tailored solutions to meet your Medicaid goals.
Unmatched industry expertise
Get a customized state-by-state approach with industry experts to develop a more complete picture of your population’s health status.
Breadth of solutions
Our advanced analytics identify current conditions for members and enables providers with this member specific data at the point of care.
Size and scale
We support more than 11M Medicaid members across more than 21 states, at more than 75,000 provider sites collecting over 30M charts a year.
Related healthcare insights
Guide
Explore Medicaid best practices for health plans and learn three actions to take and when to take them.
White paper
By applying analytics solutions, states can create a comprehensive roadmap to better health equity.
Case study
Using digital integration to ease administrative burdens can help you spend more time with patients and deliver positive patient outcomes.
Product information and resources
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Medicaid risk and quality
Learn more about how to leverage best practices to optimize and support your Medicaid risk and quality programs.
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Sell sheet
Medicaid Risk Adjustment
Find out more about the importance of having a Medicaid risk adjustment strategy.
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Sell sheet
Provider Claim Review
Learn how Optum can help coordinate provider review and claim correction for unreported conditions found in medical records.