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  • GOVERNMENT SOLUTIONS

    Personalize care for complex populations while monitoring compliance and cost

Healthcare organizations that manage government populations – Medicaid, Medicare, or dual-eligible – demand solutions tailored to the needs of their enrollees. ZeOmega understands the needs and requirements of this market, so we developed unique capabilities that support Medicare Advantage and Long-Term Services and Supports (LTSS) populations, building on our already proven solutions for managed Medicaid organizations.

Medicare Advantage

Enrollment in Medicare Advantage (MA) plans continues to grow nationwide, as does competition among those plans.

As it does, the ability to manage these high-risk populations while maintaining CMS regulatory compliance presents mounting challenges. Plans must deliver better health outcomes while they work to optimize revenues and capture data to support audits and reporting requirements.

Understanding the complexities involved in serving MA populations, ZeOmega developed Jiva for Medicare Advantage – a comprehensive package designed to support the unique needs of MA plans.

With Jiva for Medicare Advantage, you can:

Track, manage, and document appeals and grievances for Part C & D

Manage medical and pharmacy appeals and grievances on one platform

Automate complex processes through the Jiva Sentinel Rules Engine for maximum efficiency and cost savings

Quickly generate CMS audit data with out-of-the-box reporting

Jiva for MA highlights:

  • Appeals and grievances capabilities designed for MA compliance and workflow requirements

  • Automated turnaround times to support compliance monitoring

  • Out-of-the-box ODAG and CDAG universe reporting

  • Part C & D template letters

  • Embedded due date calculations

  • Dashboards for effective management of compliance timelines

  • Medicare member identifiers (MBI, Contract, Plan ID)

  • Utilization management solution that drives increased effectiveness and efficiency

LTSS

The Jiva Long-Term Services and Supports solution delivers the functionality health plans need to manage LTSS populations in a way that improves quality, cost savings, patient engagement, and operational efficiency. It provides the end-to-end capabilities needed to manage the entire LTSS lifecycle, including:

  • Auto-creation of LTSS cases based on state eligibility feeds
  • Creation of member self-interest cases
  • Configurable, complex needs assessments
  • Auto-generation of personalized care and service plans
  • Services to enable integration with state systems for the submission of service plans
  • Federal and state waivers to track budgets by service and utilization
  • Monitoring of spending thresholds
  • Alerts for over- or under-utilization of services

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PRODUCT OVERVIEW & DATA SHEET

Jiva for Medicare Advantage - Population health management with regulatory compliance

WHITE PAPER

Manage the Complex Long-Term Services and Supports (LTSS) Population Leveraging Population Health Management Technology

CASE STUDY

Jiva Surfaces as the Best Solution to Kern’s Data Integration Challenges and Fast-tracks Kern’s Vision of Seamless, Holistic Care

CASE STUDY

Achieving Medicare Advantage Productivity and Quality Goals with ZeOmega’s Streamlined, Integrated Jiva Platform

PRODUCT OVERVIEW & DATA SHEET

CMS Interoperability and Patient Access

BLOG

Overcoming the Top 5 Challenges Facing Medicare Advantage Plans




Capabilities

  • Care Management
  • Government Solutions
  • Healthcare Services Communication Hub
  • Social Determinants Of Health
  • Analytics & Reporting
  • Clinical Intelligence
  • Explainable AI
6200 Tennyson Parkway
Suite 200
Plano, TX 75024 USA
214.618.9880
Request a demo
Careers at ZeOmega

From The Blog

  • Data-Driven Relationships Catalyze Quality for Medicare Advantage Plans
  • Medicare Advantage Plans Can Boost Star Ratings with Proactive, Data-Driven Care
  • Leveraging Data to Address the Social Determinants of Health for Medicare Advantage Members

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