Oleen Pinnacle’s extensive Medicare and Medicaid experience allows us to assist current and prospective government contractors with their efforts to gain and sustain business process and information processing efficiencies. Our team members have successfully met the needs of intermediaries, carriers and program clients in achieving crucial deadlines while providing analysis, configuration and technical services to support the modification and implementation of core Medicare FFS, Medicare Advantage and Medicaid processes and systems.
Our key services include:
- Assessment/reassessment of gaps not provided in business assessment analysis
- Quality assurance & testing controls, improvement & evaluation
- Audit procedures definition or redesign
- Data warehouse services & reporting, tools & processes
- Performance standards & certification preparation assistance
- Definition & development of covered services for CPT & revenue review
- Document workflow, policies & procedures, & requirements/specifications standardization
Medicare and Medicaid Market Entry
Oleen Pinnacle routinely assists clients by measuring key factors to determine their ability to succeed as a Medicare or Medicaid contractor. The areas of focus and measurement include:
- Business knowledge
- Successful and on time deliverables
- Solid skill sets
- Project management oversight
- Thorough analytical support
- Technical & reporting
- Joint review & ongoing review
Learn more about Medicare Advantage market entry services
Gain & sustain business process & information processing efficiencies
The demand for efficient and effective government program adherence is often complex and demanding. The Oleen Pinnacle team will help you resolve government program challenges found in:
- Enrollment/membership processing
- Provider network management
- Provider contracts maintenance
- Benefits building & maintenance
- Utilization management – referrals, authorizations & certifications
- Medical policy oversight
- Call center & customer support
- Claims processing & workflow
- Medicaid special program needs – SCHIPS/EPSDT
- Medicare Advantage program needs – external EDI Files, reconciliation processing, reporting, auditing, automated processing; Ssurveys – working aged, health assessment & COB
CMS Communications
Oleen Pinnacle has the experience to guide you through the complexities of communicating with the Centers for Medicare and Medicaid Services (CMS). Our services include:
- Communication method/vehicle determination (Connect/Direct, Gentran or third party)
- The transmission of RAPS & PDE data with Palmetto
- Communication with TrOOP & COB facilitators
Medicaid Special Requirements Assessment Services
- SCHIPS – Prioritized processing for children’s programs
- EPSDT – Review & improved responsiveness of preventive medical care audit & maintenance
- Drug & NDC pharmaceutical processing
- State & Federal Liaison &reporting as needed to fulfill contractual obligations
- Monitoring programs & meeting government requirements