‘Medicare in a Box’: Simplifying Operations in Healthcare

‘Medicare in a Box’: Simplifying Operations in Healthcare

The US healthcare industry is reorienting towards a consumer-centric mindset to create a value-based healthcare system that reduces medicare services costs while enhancing the quality of care. In 2022, more than 28 million Americans are enrolled in a Medical Advantage (MA) plan. Of those who are enrolled in MA plans, 80% of them choose plans with high-quality ratings of 4 stars and above. As more and more Americans enroll in MA plans in the coming decade, there is a growing need for high-quality MA plans in the market.  

However, successfully launching and administering a MA plan is not a simple task. Although the opportunity looks promising, the growing competition and US Government regulations present unique challenges to organizations trying to penetrate the MA market. 

Wipro accomplishes this daunting task with an end-to-end software suite called Medicare in a Box to deliver healthcare operational efficiency in the shortest possible time. Our processes ensure compliance and are aligned to the industry regulations, providing greater payer-provider collaboration while focusing on high-quality beneficiary care. 

“Medicare in a Box”- Components 

Wipro Medicare in a Box is a complete solution for Medicare management. It consists of an integrated set of ready-to-use healthcare modules that increase core operational efficiency and deliver sustained cost controls for the healthcare industry. The turkey modules/ components of the software include: 

• The Member 360 module, a comprehensive end-to-end Medicare membership management system and a healthcare CRM solution that aims to deliver seamless medicare services to enhance member experience through flawless CMS submissions.

• Revenue 360 is an intelligent automation-driven reconciliation system that can store a variety of Center for Medicare and Medicaid Services (CMS) files and process CMS data fast to ensure timely and accurate medical enrollment payments for clients. 

• Wipro EDPS (Encounter Data Processing System) is a compliant processing solution ensuring 100% compliance for Medicare Advantage data submission to CMS and States while automating the manual process. 

• The Plexis QC- claims processing and management module delivers reliable performance while processing high volumes of claims allowing customers to grow as they optimize. 

“Medicare in a Box” Advantages- Simplifying Healthcare Industry Operations 

Wipro enables healthcare workflow efficiencies and accelerates growth for MA plans. The Medicare in a Box platform drives value-based care by simplifying electronic workflows, coordinating care, meeting cost objectives, and enhancing provider-payer collaboration. This agile and scalable solution offers the following benefits to enhance the US medicare services industry:

1 Improves Member Acquisition: With the speedy implementation and instant platform go-live features, organizations can achieve an improved velocity of member acquisition quickly. The various platform turnkey modules are tested and proven to provide a wide range of benefits: from interoperability to compliance with CMS and industry standards. 

2 Optimizes Payer Operations: Medicare in a Box solution improves the conversion rate of a prospect to a member by reducing the cost per claim involved in processing. With efficient and accurate MA claims and appeals processing tools, the need for adjudication/ appeals reworks reduces, ensuring greater efficiency of healthcare operations. 

3 Better Communication: Medicare in a Box comprises real-time portals connecting members, providers, and all other essential stakeholders. Members can securely access provider information, eligibility criteria, claims history, and other data fields from their smartphone, tablet, or computer with a tap. 

4 Simplifies Electronic Workflows: The platform drives enterprise-wide efficiencies with end-to-end workflows for medical enrollment data processing, claims handling, encounter data submissions (EDPS), compliance management and CMS files processing . The flexible functionalities of the platform streamline workflows for provider engagements and enhance collaboration between providers and members. 

5 Meets Compliance Requirements: By providing holistic visibility for health plans, Medicare in a Box enhances end-to-end transparency and accountability for meeting compliance requirements. The platform reduces or eliminates duplication errors to accelerate ROI for the healthcare industry.  

#6 Reduces Costs with Improved Quality of Care: Driven by analytics and intelligence, the platform captures medical risks early in the cycle and improves the quality of patient care. By leveraging platform capabilities, payers can achieve significant cost savings with real-time alerts and auto-adjudication rates to reduce the risks of claims processing incorrectly. With optimized pricing models based on membership, efficient contact centers, and customer service round-the-clock availability, enterprises can lower CapEx and OpEx costs. 

Achieve Healthcare Transformation with Wipro’s “Medicare in a Box” Solution

Wipro’s Medicare in a Box platform is equipped with Robotic Process Automation (RPA) technology to manage and automate healthcare audits, provide real-time alerts, undertake responsive reporting, ensure efficient claims management function with built-in compliance. Empowered by platform-driven intelligence, the solution transforms Medicare and Medicaid services industry by focusing on critical aspects such as member healthcare experience, social health determinants, wellness routines, care management, quality rating, and total cost of care. Leverage our platform capabilities powered by artificial intelligence and machine learning technologies to maximize member touchpoints, simplify decision-making, automate manual processes, and obtain high-quality outcomes at reduced operating costs.