Medicaid Platform

The Healthcare industry is striving to keep pace with ongoing reforms so that it can meet regulatory mandates with standardized processes and agile methodologies. The Affordable Care Act expanded Medicaid eligibility, leading to a spike in enrollment to the programs. The Wipro Medicaid solution and services represent a 100% compliant, efficient and scalable suite to run your managed Medicaid operations – IT Applications, Infrastructure and Business process services.

How Wipro Helps

Wipro's Healthcare practice has been providing Medicaid Fiscal Agent Services for more than 25 years, including MMIS modernization, member and provider contact centers and IT infrastructure services.

Our solution suite can help you with:

  • Claims Processing
  • Clinical Review
  • Member Services
  • Development and Maintenance OF Information Systems
  • Information Technology Infrastructure
  • New Technology Solutions and General Administrative Services

Our Medicaid solutions and services include:

  • IT Application and Infrastructure and Security Services:
    • Medicaid Information System maintenance, enhancements
    • Conversions, upgrades
    • Application hosting, service desk
  • Claims Administration
    • Claims data intake
    • Clearing house convergence
    • Claims adjudication
    • Prior authorization
    • Fraud and abuse
    • Payment & print distribution
    • Claims overflow
    • BPM/workflow
  • Medicaid Medical Management
    • Health Risk Assessment (Clinical and Behavioral) HRA, complex case management
    • Medicaid Care Management platform for integrated behavioral-clinical programs
    • "Feet on Street" services for case management
  • Medicaid Back-Office Operations
    • Membership and enrollment
    • Premium billing and reconciliation
    • Member and provider services
    • Membership scanning and fulfillment
    • Claims - EOB, check, correspondence printing
  • Advanced Data Analytics
    • Operations Dashboards
    • Member-centricity analysis
    • Medical Management - predictive health and cost analytics

Success Stories:

  • We are implementing an Integrated Medicaid Eligibility and Enrollment Solution for a mid-western US state. This is to assist the state in deploying a robust and comprehensive Medicaid eligibility and enrollment process to comply with mandated Affordable Care Act by Dec 31, 2015
  • As a state fiscal agent for one of the mid-western state, we have delivered tremendous value over the last 25-plus years, including:
    • Improved auto adjudication rate from 60% to 83%
    • Average processing time of 0.69 days with reduced error rates
    • 99.5% of paperless claims management covering 100-plus million claims/year
    • Improved provider satisfaction, developed a provider portal with 40,000-plus Medicaid providers and more than 175 million hits
    • Participant Services Unit (PSU) Call center - 22,500-plus telephone calls and 2,350-plus incoming correspondence
    • Enrolment Broker (EB) Call center - more than 83,500 telephone calls and 650,000-plus emails managed
    • Provider Communications Call center - 214,000-plus phone enquiries, more than 14,100 email enquiries and over 1100 written correspondence handled
    • Claims Processing - document control - 287,000-plus paper claims, 22,600-plus prior authorizations, more than 2700 paper attachments and about 60,000 managed care applications
    • Claims Processing - resolutions - 312,000-plus suspended claims and more than 3,300 suspended attachments resolved;
    • Average time to resolve - 55 second, ~100% service levels maintained
    • Pharmacy Help Desk - handled 370,000-plus telephone calls, more than 18,200 faxes and over 7,500 cyber access
    • Medical Help Desk - 15,500-plus telephone calls and more than 2,100 cyber access handles
    • Behavioral Health Help Desk - handled 13,700-plus calls and more than 21,300 faxes
    • Medical policy services - 421,000-plus claims, 20,000 PAS, 10,900-plus exceptions