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Care Compass Overview
Care Compass is a user-friendly, end-to-end solution that simplifies day-to-day care coordination, leverages analytics, and ensures compliance with Medicaid and Medicare requirements. It is a highly configurable platform that streamlines care management documentation, claims processing and payment, and enhances workflows to drive better outcomes.
Claims/TPA Services
Effectively manage and track member claims to ensure accurate, up-to-date health insurance information.
- Monitor claim status and payment updates
- Process and track medical authorizations
- Review claims resolution and payment posting
- Streamline communication between care managers, provider services, and accounting
Provider Management
Building strong relationships with providers is key to ensuring members receive the care they need.
- Track and communicate with your member’s provider team
- Review medical appointment history and provider communications
- Manage provider demographics and relationships with members
- Oversee provider credentialing
- Review contract and pricing details
- Ensure compliance with PNDS (NY) and HSD reporting requirements
Provider Portal
The PPI Provider Portal offers providers real-time access to critical information, enhancing efficiency and communication.
- Track claim payments, denials, and statuses
- View claims awaiting processing
- Use detailed search functions to find claims
- Sort and manage claims by status
- Access and download authorization data
- Download payment info 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
Call Center
Our Provider Call Center Module efficiently manages and tracks calls related to claims, eligibility, authorizations, grievances, appeals, ACH requests, portal access, and credentialing.
- Customize call scripts for admins
- Link questions to claim, patient/member, or authorization data
- Track ACH requests and follow-ups for new bank details
- Tailor workflows to ensure no actions are missed
- Track grievances and appeals with custom functions
- Generate detailed reports on call types, reasons, and details
- Monitor call times, counts, durations, and key metrics
- Route calls to internal personnel as needed
- Track performance metrics like average answer time, handle time, and first call resolution
Care Management
The Care Management module in Care Compass ensures members have the support and care they need to manage their health conditions.
- Manage current and past member encounters
- Use smart search to find members by name or phonetic spelling
- Access history of previous member look-ups for quick reference
- Customizable toolbar for quick access to key information
- Update member records easily via shortcuts
- Flag high-risk members based on primary, secondary, and tertiary diagnoses
- Search and filter by diagnosis for streamlined care management
Intake & Enrollment
Care Compass simplifies managing enrollment events, member and prospect information, and more.
- Manage marketing leads, enter notes, and attach documents
- Use "Map this Location" to easily locate members' residences and plan visits
- Administer a contact management system to eliminate duplicates
- Assign formal and informal team supports
- Enter or integrate medical, health history, and insurance information
- Receive and manage batch file updates on enrollment and eligibility status
Care Planning
Ensure the best care for your members by understanding their diagnosis and health management journey.
- Integrate member goals, issues, interventions, and outcomes
- Focus on team-based outcomes and measurable results
- Identify barriers to achieving member goals
- Schedule rehabilitation and manage durable medical equipment requests
- Track care management team schedules and tasks
- Monitor and manage interventions effectively
- Integrate with members' insurance plans
- Streamline authorizations and claims processing
Member Service Planning
Track and manage service plans to ensure your members receive the best care possible.
- Build effective care plans using assessment responses
- View care plans easily with an intuitive calendar feature
- Include emergency preparedness and hospital reporting
- Use standard or customizable emergency questions
- Customize member assessments with tracking, treatment, and diagnosis options
- HIPAA 5010 compliant
- Generate standard or customized individual and batch letters for member correspondence
Workflows
The Care Compass Workflow module streamlines team-based care management, ensuring efficiency and collaboration.
- Support for team-based care management pathways
- Assessment and service plan-based logic
- Conditional branching and alerts based on assessment or encounter responses
- User-friendly inbox interface for easy task management
- Manage and update care management team tasks
- Assign and delegate tasks to specific team members
- Integrated productivity reporting for enhanced oversight
And More...
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