» SHMS Medicare™
» SHMS Medicare ASP™
» SHMS ESI™
» SHMS HEDIS® Insight™
SHMS Medicare™ is a rapidly-installed application to manage and facilitate
all core business processes of a Medicare managed care organization. The SHMS
Medicare system is a full Windows© application providing an easy-to-use
interface that requires little training for most functional areas.
Business Process Benefits
- A central cohesive approach to all core business processes of a Medicare managed
care organization provides executive in-depth visibility into key business
performance indicators. ibility into key business
- Consistent approach and flexibility of the system results in improved
beneficiary relations and health care outcomes.
- Allows plans to delegate risk by supporting multiple capitated arrangements with
providers or external MSOs.
- Claims processing, which can be labor-intensive, is automated; claims are
auto-adjudicated based on industry-standard verifiBeneficiary history, including all claims (Part A, Part B, and Part D), lab
results, encounters, CMS transactions and payments, and utilization information,
is centrally available providing a more complete view of the beneficiary which
enables plan to better manage clinical and disease management outcomes.
- Provider relations and network management is simplified with complete
contracting, claim status and payments, and line-item EOB generation.
- Extensive reports and ad-hoc reporting tools simplify the management and
monitoring of the operational status of any functional area of the system.
Information Technology Benefits
- Rapid implementation due to extensive object-oriented software framework based
on Microsoft .NET 2.0. For new plans, implementation could be accomplished in as
few as 30 days (depending on any process customization required). For existing
plans, implementation may take as a few as 90 days (depending on customization
and data conversion requirements).
- Familiar user interface based on common office applications and extensive system
documentation allow users to get up to speed quickly.
- State-of-the-art Microsoft Windows Server 2003 and SQL Server 2005 environment
greatly simplifies administration of the system, easily integrates into existing
IT infrastructures, and also ensures scalability over time. IT staffing
requirements are also lower as a result.
- Application security is integrated
into Microsoft Active Directory allowing centralized management of access to
- Membership: Demographics, Benefits/Plan
- Providers: Contracts, Credentialing,
- Claims: Part A & Part B,
Payments, EOB generation, Adjudication Engine, Re-pricing
Management: Authorizations, Referrals, Encounters, Case Management
Interaction: Automatic sync with CMS MARx system for Enrollment/Plan
Change/Disenrollment, TRR, MMR, and many more
- Marketing: Prospects/Leads
Management, Pipeline reporting, Marketing Campaign results
- Provider Portal:
Claim/Payment status, Scorecard
- Member Portal: Eligibility Status, Claim