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Care Compass Overview

Care Compass is a fully integrated, long-term care management system that meets Medicaid and Medicare requirements. Care Compass is completely customizable and optimized to meet the needs of your members. Easy to manage interfaces, member goals/interactions and optimized workflows with a built-in rules engine make Care Compass the simple choice.

Care Compass houses seven main navigational modules broken down into the areas you need most when managing your members’ long-term care. 

Claims/TPA Services

Because coordinating members care with providers is complex, ensuring you always have the most up-to-date and accurate health insurance information is imperative.

  • Manage each member's claim status so that you remain informed on their payment status

  • Coordinate team communication between care managers, provider services and accounting

  • Medical authorization processing and tracking

  • Review claims process, resolution and payment posting

Claims/TPA

Provider Portal

The PPI Provider Portal gives providers real-time access to essential information such as contract details, member authorizations, claims, and payments.

  • .Track claim payments, denials, and overall claim status.

  • View claims awaiting processing.

  • Find claims using a detailed search engine.

  • Sort and manage claims by their current status.

  • Access and download detailed authorization data.

  • Download comprehensive payment information via PDF EOPs.

  • Obtain Remittance and Authorization files in EDI format.

  • Verify member eligibility and covered services.

  • Access reconciled EOPs with NAMI codes and functions.

Provider Management

Maintaining a solid relationship with a provider team is the foundation to ensure your members are provided with the health care they need to manage their medical conditions.

  • Track and communicate effectively with your member’s provider team

  • Review medical appointment history and provider communications

  • Track provider demographics with hierarchal relationship to member

  • Manage provider credentialing

  • Review contract and pricing information

  • Supports both PNDS (NY) and HSD reporting for regulator compliance

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Call Center

Our Provider Call Center Module manages and tracks provider calls related to claims, eligibility, authorizations, grievances, appeals, ACH requests, portal access, and credentialing.

  • Admins can customize call scripts.

  • Link questions to claim, patient/member, or authorization data.

  • Track ACH requests for new bank details and follow-ups.

  • Tailor call center workflows to ensure no actions are lost.

  • Create custom functions for tracking grievances and appeals.

  • Generate detailed reports on call types, reasons, and details.

  • Report on call times, counts, and durations.

  • Route calls to internal personnel as needed.

  • Track metrics like average time to answer, handle time, abandon rate, and first call resolution.

- Provider Portal
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Care Management

Care Management

Your job centers are ensuring that members have access to the support and care they need to manage their health conditions. The heart of the Care Compass software is the Care Management module.

  • Manage current and previous encounters

  • Smart search feature allows you to search for members by what their name sounds like or how you think it is spelled

  • Saves a history of all your previous member look-ups, making it easy to find who you recently talked with and when

  • Customizable toolbar with the important information you want at your finger tips

  • Flip through member records and update information via shortcuts 

  • Identify a member’s primary, secondary and tertiary diagnosis and flag as high-risk when appropriate

  • Easily search by diagnosis

Enrollment
Care Planning
MSP
Workflows

Enrollment

The intake and enrollment feature in Care Compass allows you to easily manage enrollment events, marketing leads, member and prospect information, enter notes, attach documents and more.

  • 'Map this Location' makes it easy to locate a member's residence and helps you navigate the best route to plan your visit

  • Easy to administer contact management system helps eliminate duplicates

  • Assign formal and informal team supports

  • Enter medical information, health history and insurance information manually or integrate from an outside source

  • Receive and manage batch file updates to enrollment and eligibility status

Member Service Planning

To ensure your members are provided with the best possible care, the ability to track and manage their service plans is crucial.

  • Use assessment responses to build an effective care plan

  • Easy-to-read calendar feature makes it simple to view the care plan

  • Emergency preparedness including hospital reporting

  • Standard and customizable questions to be asked in an emergency situation

  • Ability to build any tracking, treatment, diagnosis to customize member assessments

  • HIPAA 5010 compliant

  • Standard and customizable individual and batch letters for member correspondences

Care Planning

The way to ensure your members receive the best care is to have an understanding of their diagnosis and the path they have gone down to manage their health conditions.

  • Integrate member goals, issues, interventions and outcomes

  • Team-based outcome and measurement focus

  • Flag barriers to help identify member's goals

  • Schedule rehabilitation and manage durable medical equipment requests

  • Track and view care management team schedules and tasks

  • Manage and track interventions

  • Integrate with a member’s insurance plan

  • Administer authorizations and track with claims processing

Workflows

The workflow module of Care Compass is where it all comes together.

  • Comprehensive and effective support for team-based care management pathways

  • Assessment and service plan-based logic

  • Conditional branching and alerts based on assessment or encounter responses

  • Inbox interface similar to Microsoft Outlook enhances end-user readability

  • Enter, manage and update care management team tasks

  • Assign and delegate tasks to specific team members

  • Integrated productivity reporting 

And More...

Check out the rest of our video library to see the rest of our extensive offerings such as: Utilization Management, Mail Merge, EOP Functions, Encounter Reporting, EDI Manager, Replication, Provider Credentialling, and more...

- And more...
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