Medicaid Agency Managed Care Services

Innovative solutions to complex Medicaid challenges

Our independent and objective managed care consultants help Medicaid agencies reduce unnecessary healthcare costs and improve program outcomes, quality, and oversight with the goal of enhancing the experience of Medicaid beneficiaries.

With ever-changing and newly enacted regulations in the healthcare industry, we help you find innovative solutions that improve delivery of appropriate, medically necessary, and quality healthcare to your beneficiaries, including oversight and program management of health plans contracted with your state. From strategic planning to compliance, payment models, and agency organization, we can help you solve your toughest challenges.

Medicaid consulting services

We provide key insights to Medicaid agencies seeking opportunities to improve their delivery of services, expand and manage provider networks, and mature provider payment models. We can help you oversee benefits and services through contracted arrangements with Managed Care Organizations (MCOs).

Compliance consulting

Organizational consulting

Project management and planning

Readiness review assistance

Managed care policy analysis

Population expansion guidance

Encounter data services

Actuarial services

Compliance consulting

Our experienced compliance team can help you stay compliant with all relevant compliance frameworks, including federal, ACA, COVID-19, and HIPAA. We also have extensive expertise in supporting mental health parity compliance related to the Mental Health Parity and Addiction Equity Act (MPHAEA).

Organizational consulting

We partner with you to holistically optimize your organization, assess what’s working, and identify areas for improvement. Leveraging best practices and proven methodologies, we help you with business process improvement, change management, and organization development, so your team is optimally aligned to your strategy.

Project management and planning

Our experienced project management team partners with you to strengthen your agency in a variety of capacities from the beginning of a project to the end. We help with all aspects of a project, including requirements gathering and RFP development, quality assurance, strategic planning, and Medicaid Information Technology Architecture (MITA) assessments.

Readiness review assistance

We help you ensure operational readiness and pass joint CMS/state readiness reviews for your managed care program. Our thorough process includes desk-level review assessments and systems review demonstrations.

Managed care policy analysis

Our Medicaid policy experts help you gain insight into federal and state healthcare policy and legislation analysis to successfully navigate the complex legislative environment. We advise on documentation development in eligibility and enrollment, member and provider communications, and corrective action plans.

Population expansion guidance

We partner with you to explore and understand expansion options and considerations for “carving in” services and populations into your managed care program, advising on management and implementation.

Encounter data quality assurance services

Our team of healthcare data analysts and Medicaid Enterprise System (MES) experts specialize in evaluating MCO encounter data quality. We assess data from the MCO source through your Medicaid Management Information System (MMIS) and data warehouse. We identify data quality issues and collaborate with your system vendors on a remediation plan.

Actuarial services

Our healthcare actuaries perform complex analyses and provide strategic advice on pricing and cost decisions. We understand the issues and provide actionable recommendations that mitigate financial risk and improve access for Medicaid populations.

Areas of expertise

With ever-changing and newly enacted regulations in the healthcare industry, BerryDunn’s team helps Medicaid agencies develop innovative solutions for complex problems.

Managed care contracting

We help you deliver Medicaid program healthcare services to beneficiaries, reduce Medicaid program costs, and better manage utilization of health services.

Program enhancements

Our team guides you through innovative program enhancements, large-scale implementations, systems updates, and MCO compliance efforts to reduce programmatic costs and meet regulatory expectations.

Integrated care solutions

We advise you on how to improve care for populations with chronic conditions, align payment incentives with performance goals, and build in accountability for high-quality care.

Utilization and reimbursement strategies

We help you rethink the control of program costs, find program flexibilities to expand coverage such as telehealth, and make operational changes to support growing member populations.

Provider networks and payment models

Our experienced team helps you assess and plan for the development of provider networks and payment models.

How BerryDunn can help

BerryDunn's Medicaid Practice Group helps Medicaid agencies improve the health and lives of individuals by empowering, inspiring, and partnering with our clients—we innovate, share deep expertise, and provide an independent perspective to resolve challenges. We are the success partner for Medicaid agencies, building healthier communities and stronger futures.