Care/Medical Management

Now, more than ever, Payers must rise to the challenge of ensuring quality care for their members while minimizing the cost of that care. Improving outcomes for members, ensuring profitability and regulatory compliance are high on the list of goals for all Payers. As a result of this environment, the Care Management system industry is rapidly growing and Payers must navigate their way through a sea of vendors to find the systems that will best accomplish their unique set of goals for managing care. FluidEdge consultants are some of the most experienced individuals in the industry at assessing, procuring and managing the implementation of these applications. Our consultants come from backgrounds including both Payers and Care Management vendors, so can offer a unique perspective on the challenges facing our customers in achievement of their Care Management initiatives.

Here are some of the system initiatives that FluidEdge has engaged in with our Payer customers in the area of Medical Management:

• Complex Case Management
• Utilization Management
• Disease Management
• Clinical Outcomes and Predictive Modeling
• Fraud & Abuse Identification and Claims Payment Accuracy
• Benefit Design
• Member & Provider portals
• Health Information Exchange (HIE)
• ICD-10 Coding
• HIPAA 5010 compliance
• EMR Implementations

These are only a few of the initiatives with which FluidEdge consultants are engaged. As both government regulation and the industry evolve, FluidEdge is there with the tools our customers require to navigate the change.