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MAXIMUS Simplifies Medicaid Program Management With DecisionPoint Solutions

MAXIMUS (NYSE:MMS), a leading provider of government services worldwide, announced today that it has released a new set of solutions, called DecisionPoint TM, to help states navigate the complexities of Medicaid Expansion. The formal debut of these solutions will begin today at the Medicaid Enterprise Systems (MES) Conference in Denver, Colorado.

DecisionPoint combines comprehensive data with proven processes and technology to empower states to make fast, accurate Medicaid program decisions. DecisionPoint is designed to efficiently close information gaps across all subsidy categories at every stage of the Medicaid lifecycle. The DecisionPoint solutions address areas such as program integrity, provider management services, premium assistance, informal dispute resolution, and business intelligence.

“Health care reform brought millions of new beneficiaries into the Medicaid system. States are striving to efficiently and accurately provide health insurance to this influx of people, while complying with a new set of mandates,” said Bruce Caswell, President and General Manager of MAXIMUS Health Services. “In this time of complex challenges, we designed DecisionPoint to arm Medicaid Directors with the tools they need to simplify program management and ensure the right people get the right services, all while maximizing use of taxpayer dollars.”

The catalyst for the rapid growth in Medicaid applicants and beneficiaries is the implementation of the Affordable Care Act (ACA). The Act includes changes to eligibility requirements, along with increased public awareness that has attracted beneficiaries who were previously eligible, but had not applied. This surge in activity has resulted in large amounts of inaccurate and incomplete member data pouring into legacy state Medicaid systems that were not built to handle today’s increased volumes or updated requirements. To help Medicaid Directors scale to meet current demand and maintain long-term program sustainability, DecisionPoint from MAXIMUS delivers a set of solutions for various stages of the Medicaid lifecycle:
  • DecisionPoint for Program Integrity ensures that rapidly growing member populations are accurately placed in the correct Medicaid categories. Leveraging the best available data from multiple sources, the solution aggregates, validates and analyzes information to deliver a comprehensive view of each applicant. MAXIMUS experts apply proven processes to the data, helping state eligibility staff quickly make the right decisions at the right time.
  • DecisionPoint for Provider Management Services streamlines provider screening and enrollment processes to ensure states have a trusted, credentialed source of providers. It also enables states to implement a new slate of services that support managed care, but stand apart from legacy Medicaid Management Information Systems (MMIS) that are unable to accommodate the new volume of applicants and the changing requirements. MAXIMUS experts partner with states to allow for timely, informed decisions throughout the provider continuum.
  • DecisionPoint for Premium Assistance helps states design and implement Medicaid programs that encourage consumers to make informed choices through the use of Health Insurance Premium Programs (HIPP). By combining improved engagement during enrollment with simplified processes for premium management, DecisionPoint for Premium Assistance lessens the burdens on employers, streamlines the facilitation of payments, and leads to outcome-driven decision-making that benefits eligible citizens.
  • DecisionPoint for Informal Dispute Resolution helps states address an applicant’s eligibility concerns as they arise, delivering independent engagement services that lead to quick resolutions. Highly trained MAXIMUS experts help citizens understand eligibility criteria early in the process, resolving issues before they escalate into costly hearings. If disputes cannot be resolved through early intervention, DecisionPoint for Informal Dispute Resolution automates the process of case formulation, enabling states to navigate the fair-hearing process quickly and efficiently.
  • The DecisionPoint Business Intelligence (BI) Engine is a cloud-based IT solution that provides states with the insight needed to make accurate, timely Medicaid program decisions while maximizing resources. The DecisionPoint BI Engine uses sophisticated analytics to automate data collection and analysis from multiple sources, ensuring a comprehensive view of current beneficiaries and new applicants. States can access real-time and predictive views of their entire operations through a single intuitive dashboard, enabling simplified insight into project status, performance metrics and staffing optimization.

During the Medicaid Enterprise Services Conference this week, MAXIMUS Vice President Pat Aguilar and Dennis Elliott, Director of Provider Services for TennCare, will be sharing their success with the DecisionPoint for Provider Management solution for Tennessee’s Medicaid managed care program. The MAXIMUS exhibit booth will also feature a demo of the DecisionPoint for Program Integrity solution, as well as in-depth information for all five solutions. MAXIMUS experts will be present to discuss how the solutions can help states improve their Medicaid programs.

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