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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 and testing controls, improvement, and evaluation
- Audit procedures definition or redesign
- Data warehouse services and reporting, tools, and processes
- Performance standards and certification preparation assistance
- Definition and development of covered services for CPT and revenue review
- Document workflow, policies and procedures, and requirements and 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 and Reporting
- Joint Review and Ongoing Review
Learn more about Medicare Advantage market entry services
Gain and sustain business process and 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 and Maintenance
- Utilization Management – Referrals, Authorizations and Certifications
- Medical Policy Oversight
- Call Center and Customer Support
- Claims Processing and Workflow
- Medicaid Special Program Needs - SCHIPS / EPSDT
- Medicare Advantage Program Needs – External EDI Files, Reconciliation Processing, Reporting, Auditing, Automated Processing; Surveys – working aged, health assessment and 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 and PDE data with Palmetto
- Communication with TrOOP and COB facilitators
Medicaid Special Requirements Assessment Services
- SCHIPS – Prioritized processing for Children’s Programs
- EPSDT – Review and improved responsiveness of preventive medical care audit and maintenance
- Drug and NDC pharmaceutical processing
- State and Federal Liaison and reporting as needed to fulfill contractual obligations
- Monitoring programs and meeting government requirements
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