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:
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
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