MESC: Streamlining the Applicant Eligibility Experience with Program Integrity

compliance in healthcare

Rich Huffman, Sr Director – Identity Product Management, recently presented at MESC  on how to improve program integrity by understanding applicant eligibility early in the process.

Public health and welfare outcomes are enhanced when members smoothly access the correct programs. States, exchanges, and human services programs need to balance the applicant experience with the need for integrity and efficiency in enrollment. The use of advanced data sets combined with analytics provides a more complete understanding of an applicant and where that person fits in a constellation of public and private programs. These same analytics can ensure that the members “land softly” in the dynamically changing health and welfare environment.

Employing applied analytics across programs allows case workers to quickly assess applicants and offer membership solutions with minimal delays. Analytic tools also help streamline manual review processes to reduce expense and facilitate compliance to federal and industry regulations. In this session learn about the next generation of applicant and member verification and how advanced data allows for program efficiency, member satisfaction, cost savings and enhanced health and welfare outcomes.