Medicaid PPS Overview

Minimize Risk

Managed Medicare payers are challenged to minimize costs while managing risk. Adopting State Medicaid fee-for-service (FFS) models based on the Prospective Payment System (PPS) for reimbursement of participating (PAR) or out-of-network (OON) claims can make these challenges easier to overcome by streamlining contracting, financial and administrative practices.

Highlights

• Automated regulatory content updates
• Over 20 state- and payer-specific payment systems
• More than 40 Managed Medicaid plans using the solution

The Right Tools for the Job

Without the right tools, PPS can be extremely difficult to manage because regulatory changes are frequent and complex. With the Medicaid PPS solution, you benefit from automated regulatory content updates to more accurately process claims.

Experience

OptumInsight is a leading provider of PPS solutions that empower payers to control costs and manage risk using PPS, with more than 160 payer customers, including over 40 Managed Medicaid plans.