End-to-End Solutions & Services

With decades of experience in Government Sponsored Health Programs, we understand the challenges you face managing your Medicare, Medicaid and ACA plans. Our suite of services can support all of your Government programs and includes:

  • Enrollment Reconciliation between plan system and government files
  • Discrepancy and Revenue Recovery Analytics and Clean-up Support for enrollment, special status and coordination of benefits
  • Comprehensive Operational Assessment and Remediation Services
  • New Plan, Expansion and System Implementation Services
  • Customized solutions to create an efficient and compliant Medicare Operations team
  • Solutions Engineering and large-scale data mining, analysis and management
DISCREPANCY AND REVENUE RECOVERY ANALYTICS & CLEANUP

DISCREPANCY AND REVENUE RECOVERY ANALYTICS & CLEANUP

Let our team help you drive down discrepancies and increase revenue.

  • Analyze your enrollment, billing and claims data to identify discrepancies and revenue opportunities
  • Perform a comprehensive end-to-end reconciliation to CMS/State files
  • Provide clear, actionable recommendations for reconciliation and revenue recovery
  • Manage and clean up discrepancies and close your revenue gaps
OPERATIONAL ASSESSMENT AND REMEDIATION SERVICES

OPERATIONAL ASSESSMENT AND REMEDIATION SERVICES

Whether you are looking for efficiencies, a more scalable infrastructure or need to remediate compliance gaps, our staff of consultants will:

  • Perform an end-to-end assessment of your operational functions
  • Identify areas of non-compliance and opportunities for improvement
  • Perform a risk assessment based on our extensive knowledge of member impact and financial impact
  • Provide the clear action steps your organization needs to excel and grow
  • Develop and drive business process redesign plans
NEW PLAN, EXPANSION & SYSTEM IMPLEMENTATION SERVICES

NEW PLAN, EXPANSION & SYSTEM IMPLEMENTATION SERVICES

Madena experts have implemented new plans, services and systems for decades. We understand the integration of people, processes and technology. Our team will:

  • Apply industry-leading understanding of regulations to your processes and systems
  • Create comprehensive requirements, documentation and testing
  • Integrate end-to-end solutions of government programs across your entire organization

More End-to-End Services

Premium Billing Premium Billing
Ensure accuracy of billing, including premium subsidy and penalty processing.
Call Center Operations Call Center Operations
Training, documentation and system integration are keys to quality member service.
Appeals & Grievances Appeals & Grievances
ODAG process design, compliance remediation and CMS audit readiness.
Policy Development & Training Policy Development & Training
Customized onsite or online training for you and your staff.
Operational & System Gap Analysis Operational & System Gap Analysis
Know what is driving your administrative costs and compliance risks.
Coordination of Benefits & Medicare Secondary Payer Coordination of Benefits & Medicare Secondary Payer
We perform end-to-end capitation recovery and cost avoidance.
Independent Certification & Attestation Reports Independent Certification & Attestation Reports
We certify the accuracy of your data and reconciliation to deliver confidence in your tools and processes.
Audit & Compliance Dashboard Reporting Audit & Compliance Dashboard Reporting
Create transparency and visibility with customized reporting in the Madena Portal.