The North Carolina Division of Well being and Human Providers’ Wholesome Alternatives Pilot (HOP) lately applied the potential to confirm member eligibility inside the Unite Us closed-loop referral platform. Care managers can tie Medicaid info to an individual’s report to be mechanically notified about their Medicaid eligibility standing.
Not solely does this assist facilitate social care, but in addition ensures Medicaid members promptly deal with lapses in protection, in response to Unite Us. The corporate mentioned it’s the first social care know-how resolution to combine real-time member eligibility verification with closed-loop referral administration by way of 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 group assets – and permit for a suggestions loop on the end result of that connection.
“The Wholesome Alternatives Pilot is a first-of-its-kind modern program that’s described as a ‘life changer’ for hundreds of North Carolina households,” mentioned Maria Ramirez Perez, affiliate director for Wholesome Alternatives, in an announcement. “The success of HOP is a product of collaboration with companions throughout the healthcare, social assist, and know-how sectors. The flexibility to combine our Medicaid Administration Data System (MMIS) with Unite Us has improved our social care reimbursement workflow in verifying Medicaid eligibility. As we had been on the lookout for efficiencies and time financial savings for our system’s care managers, integrating our MMIS was an enormous win.”
“By leveraging this performance, we will now allocate HOP’s assets extra effectively and successfully, guaranteeing that Medicaid members obtain the assist they urgently want in crucial areas corresponding to housing, meals safety, transportation, interpersonal security, and poisonous stress mitigation. This builds on the prevailing long-time partnership between HOP and Unite Us, underscoring our dedication to delivering focused help the place it issues most and in the end bettering 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 companies at scale from inside the referral platform, to additional streamline the reimbursement course of for community-based organizations (CBOs) and suppliers delivering companies.
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 present utilizing Funds to streamline Medicaid billing for CBOs beneath their health-related social wants local weather profit program.
“This new integration is a big milestone in our mission to broaden entry to important social companies,” mentioned Raffaelle Breaks, chief product and know-how officer at Unite Us, in an announcement. “With Unite Us member eligibility verification, we equip care managers with the power to examine for Medicaid eligibility forward of enrollment, guaranteeing well timed assist for beneficiaries and a extra environment friendly workflow for care managers.”
