管理式医疗机构
As managed care organizations (MCOs) navigate regulatory shifts and drive change across programs, their priorities are spread across the healthcare landscape. From improving efficiencies to elevating experiences to forecasting future risk, 他们面临许多挑战. With decades of experience helping MCOs simplify the complex, Gainwell has proven solutions and experts you can trust to streamline processes and gain value.
We are passionate about empowering MCOs to achieve better care coordination that ultimately yields better health outcomes.
Modernization Support Across the Care Continuum
提高护理标准
平衡成本
识别风险
足球外围平台如何提供帮助
Our services and solutions are purpose-built to intelligently mitigate risk, streamline the most complex processes and improve the overall quality of care delivered.
Our 利益协调 solutions are innovative, creating unmatched cost and claim clarity, while our 付款的完整性 tools root out claims that are erroneous for any reason, at any stage in the claim cycle. All of these solutions are bolstered by AI and machine learning to keep you on the leading edge, 总是领先一步.
利益协调
预付款的全球十大外围足球平台
Our goal is always to maximize cost avoidance for your plan. Our tenured market expertise pairs with end-to-end COB solutions to amplify speed to delivery and provide truly actionable insights.
复苏后付费
Our Post-Payment solutions leverage AI and machine learning to examine improperly paid claims. Then, we pursue those recoveries using proven, efficient digital processes to maximize savings.
病例管理
Our 病例管理 solution makes sense of complex data and drives cases to reimbursement and closure. 足球外围平台提供安全的服务, 可靠的, web-based access around the clock — with real-time updates, document imaging and a guided workflow. Our case managers and attorneys are unmatched when it comes to complex, high-dollar cases.
付款的完整性
临床索赔审查
Our 临床索赔审查 identify coding, 位置, level of service and reimbursement errors by comparing claims against medical records — either pre- or post-pay.
资格认证
Our 资格认证 solution not only effectively handles verification, but also prioritizes employee clarity — ensuring they know why someone is ineligible.
FraudCapture®
FraudCapture是模块化的, cloud-hosted platform that provides end-to-end support in the identification of fraud, 浪费和滥用, exposing issues through clear visualization and easy-to-navigate exploration tools.
付款方式分析
Customize your post-payment solution to meet your specific needs. We use proprietary data analysis tools to compare claims history across many criteria that client systems or claim processors often miss.
护理管理
Our interoperable 护理管理 platform is built on a foundation of automation, standardization and mature processes, 利用已证实的数据, industry-standard COTS products.
利用管理
利用管理 addresses your most pressing needs by combining cost management with accurate pre- and post-payment claim reviews and prior authorization from our Clinical Care Reviews.
足球外围平台可以帮忙. 但下一步是你的了!
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