Healthcare Claims Management | Medicaid Solutions

Our Expertise

Leverage Medicaid Fiscal Agent Services backed by 25+ years of experience to meet the challenges of industry reforms and regulatory requirements

Wipro’s Medicaid platform represents a 100% compliant, efficient and scalable suite to run managed Medicaid operations for clients. The service meets client needs related to IT Applications, Infrastructure, Security, Hosting, Business Processes and Service Desk. Through these services we ensure clients can keep pace with ongoing reforms and regulatory mandates. Our service excellence, critical to client success, is the result of 25+ years of experience in providing Medicaid Fiscal Agent Services that include:

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 analysis

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