The client is the largest Medicaid managed care organization in the U.S

Business Challenge

The client’s strategic objective was to decrease administrative burdens, enhance performance in the context of risk adjustment, and attain precise understanding of members. This included furnishing comprehensive insights into the conditions of these members, thereby enhancing the overall information available to provider-partners.

Streamlined operations for a Medicaid managed care organization through automation, reliable infrastructure, and integrated supplementary functionalities
Over the course of 5 months, Infinite facilitated the bi-directional exchange of information through automation to enhance the visualization of member statuses.

The solution was hosted within the OptaFi Azure Tenant, ensuring a robust and reliable infrastructure.
Other supplementary functionalities, including HEDIS/Quality, Prior Authorization, and Utilization Management, were successfully integrated.
The proposed solution involved implementing essential features as:

1) Clinical Data Exchange 2) Image Exchange 3) Additional Detail Requests 4) Risk Adjustment