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Friday, July 12, 2024

N.C. Wholesome Alternatives Pilot Platform Integrates Medicaid Eligibility Verification


The North Carolina Division of Well being and Human Providers’ Wholesome Alternatives Pilot (HOP) just lately carried out the potential to confirm member eligibility throughout the Unite Us closed-loop referral platform. Care managers can tie Medicaid data to an individual’s report to be routinely notified about their Medicaid eligibility standing. 

Not solely does this assist facilitate social care, but additionally ensures Medicaid members promptly tackle lapses in protection, based on Unite Us. The corporate stated it’s the first social care know-how resolution to combine real-time member eligibility verification with closed-loop referral administration through X12 EDI 270/271 transactions.

HOP was established to check and consider the affect of offering choose evidence-based, non-medical interventions associated to housing, meals, transportation and interpersonal security to high-needs Medicaid enrollees.

North Carolina DHHS is also constructing a statewide coordinated care community (NCCARE360) to electronically join these with recognized wants with neighborhood assets – and permit for a suggestions loop on the result of that connection.

“The Wholesome Alternatives Pilot is a first-of-its-kind revolutionary program that’s described as a ‘life changer’ for 1000’s of North Carolina households,” stated Maria Ramirez Perez, affiliate director for Wholesome Alternatives, in a press release. “The success of HOP is a product of collaboration with companions throughout the healthcare, social help, and know-how sectors. The power to combine our Medicaid Administration Info System (MMIS) with Unite Us has improved our social care reimbursement workflow in verifying Medicaid eligibility. As we have been in search of efficiencies and time financial savings for our system’s care managers, integrating our MMIS was a giant win.”

“By leveraging this performance, we are able to now allocate HOP’s assets extra effectively and successfully, guaranteeing that Medicaid members obtain the help they urgently want in important areas equivalent to housing, meals safety, transportation, interpersonal security, and poisonous stress mitigation. This builds on the present long-time partnership between HOP and Unite Us, underscoring our dedication to delivering focused help the place it issues most and finally enhancing well being outcomes and fostering stronger, extra resilient communities,” Perez added.

The performance builds on Unite Us Funds, an built-in functionality that permits reimbursement for social care providers at scale from throughout the referral platform, to additional streamline the reimbursement course of for community-based organizations (CBOs) and suppliers delivering providers. 

A number of states depend on the funds resolution as a key element of their Medicaid initiatives’ infrastructure, together with Oregon, the place 9 Coordinated Care Organizations are at the moment utilizing Funds to streamline Medicaid billing for CBOs beneath their health-related social wants local weather profit program.

“This new integration is a major milestone in our mission to broaden entry to important social providers,” stated Raffaelle Breaks, chief product and know-how officer at Unite Us, in a press release. “With Unite Us member eligibility verification, we equip care managers with the power to test for Medicaid eligibility forward of enrollment, guaranteeing well timed help for beneficiaries and a extra environment friendly workflow for care managers.”

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