SHMS Medicare ASP™
SHMS Medicare ASP™ takes the ease and simplicity of the SHMS Medicare™
application and provides a complete outsourced ASP solution which significantly
decreases implementation time and costs as well as ongoing technical staff
requirements. The application and data are hosted in our world-class datacenter
and made available over the Internet using secure HIPAA-compliant communications
protocols. 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
- 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 verification crosswalks, CCI edits,
LMRP, and referral/auth matching. Claims are then automatically repriced using
the defined provider contract and/or Medicare fee schedule.
- Beneficiary 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 20 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 application features.