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Wipro's cloud-native platform streamlines Medicaid agency operations, enhancing efficiency and adaptability.
With simplified upgrades and robust support infrastructure, the platform addresses the complexities of modernizing outdated legacy systems while providing the agility to meet evolving demands, so agencies can spend less time on system maintenance and more on strategic initiatives.
Key Features
Wipro’s Core Claims Administration platform equips Medicaid agencies with the tools to streamline core processes and elevate operational efficiency:
- Fee-for-Service and Encounter Shadow Pricing: Optimize payment structures with precise and flexible pricing options.
- EDI Processing: Experience seamless electronic data interchange for faster, error-free transactions.
- Business Rules Engine: Implement and manage complex rules with an intuitive interface, ensuring compliance and operational consistency.
- Capitation Payments: Efficiently manage periodic, pre-arranged payment models with our automated system.
- Advanced Pricing Models: Support value-based payment arrangements to incentivize high-quality care.
- Service Categories Management: Organize and track services with ease, enhancing claim categorization and processing.
- Duplicate Claim Detection: Employ sophisticated algorithms to prevent payment errors and maintain financial integrity.
- Spend Down Calculations: Accurately determine patient liability with automated spend down functionality.
- Administrative Lock-in: Control and monitor beneficiary access to services, ensuring appropriate utilization.
- CMS Reporting Categories: Simplify reporting with pre-defined categories that align with CMS requirements.
- Correspondence Management: Automate communication workflows for consistent and timely stakeholder engagement.
Experience streamlined operations and improved accuracy with Wipro EMaaS advanced claims administration solution.
