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Utah Medicaid & MCO Claims Processing
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Claims routed accurately based on Fee-for-Service, ACO, managed care, and waiver eligibility with Utah-specific billing logic
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25–40% reduction in denial rates with faster reimbursement cycles.
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Claims submitted within 24–48 hours
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Eligibility Verification & Monitoring
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Real-time eligibility checks aligned with Utah’s retroactive eligibility rules, ACO attribution models, and managed care enrollment changes
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Reduction in eligibility-related denials by 30–45%
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Instant/ Within 24 hours
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Prior Authorization Management
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End-to-end tracking of service-specific, provider-specific, and time-bound authorizations required under Utah Medicaid
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40–60% reduction in PA-related denials
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3–5 business days
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Provider Enrollment & Revalidation
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Utah Medicaid enrollment, revalidation, and MCO credentialing, aligned with current state workflows
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Eliminates enrollment related denials.
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3-4 weeks
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Behavioral & Physical Health Billing Support
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Correct routing of behavioral and physical health claims to prevent cross-program denials
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Improved reimbursement for integrated care visits
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24–72 hours
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Timely Filing Management
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Monitoring of Utah Medicaid and MCO-specific filing limits to prevent revenue loss
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Significant reduction in late-filing write-offs
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Ongoing, automated
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Denial Management
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AI based tools to track and flag denial codes and root-cause analysis tailored for Medicaid claim categories, identifies high-risk categories and automate resubmissions.
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Reduce rate of denial by 75% and with quicker appeals.
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7–14 days for backlog cleanup; ongoing daily follow-up
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Patient Statements & Follow-Up
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Communicate with patients and give Explanation of Benefits (EOBs). Includes text/email payment reminders and online payment options.
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Reduces overdue balances and increases the collection rates.
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1-2 weeks
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Audit & Compliance Support
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Conducts Audit Review and mock audits, including documentation, encounter verification, and claim reconciliation.
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Minimizes risk of penalties and supports successful audits.
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Ongoing, depending on audit schedule
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