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Successful SOMOS Program Implementation through Utilization Management

Veracity directs IPA through Utilization Management implementation with several MCOs.

Successful SOMOS Program Implementation through Utilization Management

When our client, a leading health solutions provider that focuses on treating the whole person, needed help rolling out a new program impacting over 30,000 Medicaid lives, they turned to Veracity’s team of healthcare consultants to lead the way. Our subject matter experts stepped in to define and deliver technology-enabled solutions as well as the onboarding of external data to ensure critical information would be available for the UM Staff, Providers and Care Team. When new data requirements were uncovered, our team oversaw the development of an ASC X12 TR3 standard 278 authorization extract exchange. In addition to driving requirements and delivering digital tools, we worked to ensure our client’s compliance with NCQA SLAs and Article 49 rights as it pertains to member and provider appeals and grievances. We directed go-live activities and led operational readiness, including authoring P&Ps, and completing MCO pre-delegation audit requirements. These efforts ultimately led to a modern and innovative program for our client.

Services

  • Client Implementations

  • Process Optimization & Governance

  • Systems Integration

  • Client Implementations

  • Process Optimization & Governance

  • Systems Integration