MedHOK understands the unique challenges that health plans and healthcare organizations face, because most of our team have been there. Driven to solve these challenges, MedHOK has developed the industry’s only Unified Payer Platform (UPP), which brings together all continuum of care applications across medical and pharmaceutical disciplines to enable all major lines of business. MedHOK built the Unified Payer Platform from the ground up, starting with a solid foundation of compliance, to consolidate dozens of disparate applications into a single platform, enabling automated workflows, simplifying processes, improving productivity, and ensuring compliance.
MedHOK’s Unified Payer Platform gives you total control, and provides a strong foundation for adapting to value-based healthcare, a payment model that requires a focus on the member, collaboration and communication with providers and business partners, meeting compliance demands, and a system that facilitates these initiatives in order to increase revenue.
Click the sections below or the graphic for an overview of each component.
The following functionality comes standard as part of the Unified Payer Platform:
MedHOK unifies medical and pharmaceutical member information into one platform, fueling automated workflows and creating a true 360-degree view of the Member. The Medical/Rx Care components encompass a full range of care management functionalities including:
MedHOK’s Unified Payer Platform provides full-function member engagement through proactive functions such as Health Education and Outreach, as well as a range of responsive functions such as:
Success in value-based healthcare is not only measured in Stars, but in overall regulatory compliance, member satisfaction, audit preparation, and revenue realization. MedHOK enables Payers to become Five Star Success stories with Pay for Quality components including:
Collaboration and cooperation among all stakeholders is necessary in value-based healthcare. The MedHOK Unified Payer Platform enables healthcare payers to engage and build communities with members, providers, and business partners, with these functionalities:
MedHOK's Unified Payer Platform was built from the ground up with compliance as its foundation. With built-in rules and regulations, MedHOK is 100% out-of-the-box compliant with Medicare, Medicaid, Commercial and Exchange lines of business. Plus, because MedHOK is a Software as a Service (SaaS) application, compliance is proactively updated for perennial compliance adherence.
By Marc Ryan
The Trump administration’s announcement that it will entertain work requirements for eligibility for Medicaid is just one small example of the huge political gulf that exists on reforming Medicaid policy nationally. But it could eventually lead to compromise on Medicaid.
MedHOK’s Unified Payer Platform to deliver seamless, interactive medical reviews and enable automated authorizations through integration of InterQual Connect from Change Healthcare
Ensure effective and compliant enrollment efforts without the complexity and pain.
As enrollment functions are increasingly being targeted by regulatory agencies, the need to be compliant with emerging requirements while balancing improved efficiency and effectiveness of enrollment efforts is critical to health plan success. Learn how to stay in front of emerging compliance requirements and drive greater success from your enrollment efforts.