Services
Learn more about the Managed Care Services offered by Sanchez Managed Care Solutions
Audit Readiness & Prep
The SMCS team is comprised of former NCQA reviewers and CMS/Medicaid program managers and can handle your NCQA, Medicaid and CMS audit readiness and preparation.
Claims Payment
The prompt and accurate payment of provider claims is an expectation of all regulators. SMCS can improve the promptness, accuracy and value of MCO/ACO claims payment. The teams is comprised of very experience claims payment managers.
Contracting
SMCS is very experienced in negotiating and evaluating health plan, facility, provider, DME, pharmacy and ancillary agreements, particularly risk and capitated contracts.
Care Management
The expectation of the ACA, CMS and Medicaid is to improve outcomes for enrolled members. The SMCS team is comprised of very experienced and effective physical and behavioral health case managers, nurses, social workers and psychiatric social workers. As members are empowered to manage their chronic diseases, become more compliant with treatment plans and engaged with their providers their health outcomes improve.
Informatics
SMCS brings to the MCO or ACO the state of the art in informatics to ensure access to the most accurate, timely and actionable data to enable the organization to control processes, costs, improve outcomes. The instantaneous integration of the EMR, pharmacy data, prior authorization data and claims data is now available.
Utilization Management
The SMCS team is particularly strong and effective in controlling and reducing the cost of the fraud, waste and over-utilization of services to Medicare, Medicaid and Duals’ members. The SMCS medical directors and UM nurses have all previously held UM positions in the nation’s most successful MCOs.
