Medicare Advantage

Knowing that your core administrative platform provides the necessary level of compliance and accountability in claims and utilization management is key for IPAs and MSOs on behalf of their client organizations. The rapidly increasing administrative requirements in Medicare, along with need for integrated care management to identify and address high-risk members is key to succeeding in this dynamic market. 

Together with our point solutions, EZ-Suite drives compliant, trusted core benefits and claims administration excellence. 

• Maximize electronic data interchange, accelerated time to value and flexibility for expansion
• Control complex processes involving benefit plans, provider contracts, and member populations
• Manage to critical compliance and regulatory demands of the Medicare program
• Leverage actionable analytics to identify and provide care to high-risk/high-utilization members
• Supports comprehensive data needs through collection of provider and member profiles, health plan benefit data, primary care encounters, specialists, authorizations, physician and hospital FFS claims, risk sharing arrangements, and industry standard codes required for end-to-end UM, QM, and claims processing
• Flexibility as models change for calculation of member months via a variety of methodologies: % of Premium, Risk-Adjusted, Tiered Membership or the more traditional health plan benefit option, primary care physician, member condition, age and gender
• Automates timely and accurate payment to capitated providers based on PMPM expenses
• Drive high-quality member and provider engagement
• Support role-based user and security at the module, screen and field level
• Enable Full security settings for login attempts, forced password changes, and minimum password requirements
• Complete before and after editing; Audit Trail at the field level

Widely used and always trusted, EZ-Suite delivers the most comprehensive and tested Medicare core eligibility, claims, benefit and authorization platform.