Everything about value-based healthcare focuses around the care of the member, and so should your system. MedHOK looks at Member Engagement through the lens of the members’ complete experience. Successful engagement meets the member at all points of contact and through their preferred methods of engagement.
MedHOK’s Unified Payer Platform provides full-function member engagement through proactive features, such as Health Education and Outreach, as well as a range of responsive functions, such as Member Portal, Customer Relations, Complaints Tracking, Grievance resolution, and world-class service enablement. Plus, MedHOK records every interaction, including all current and archived cases, prior authorizations, interventions, appeals, grievances, complaints, over-the-counter medication, clinical surveys, notes, correspondence, and more, at the patient level for easy retrieval and audit.
With real-time access to member data, MedHOK's Unified Payer Platform enables payers to more effectively provide education and outreach to members, and be responsive to their needs. As a result, high member satisfaction and thus, high Star ratings, are possible.
MedHOK delivers proactive and responsive member engagement capabilities through health education, outreach tools, and world-class customer support capabilities.
Learn more about the Member Engagement components in MedHOK's Unified Payer Platform by clicking the titles below.
MedHOK delivers an unparalleled 360-degree view of the member, with real-time access to members’ complete medical and pharmacy care history, eligibility, benefits, demographics, provider info and all activities, interactions, documents, etc., in one repository, accessible from anywhere in the MedHOK platform.
360Member is used by all associates in performing their daily functions. The 360Member Profile includes:
The beauty of the MedHOK Unified Payer Platform SaaS architecture is that access can be managed at the role level for internal and external users. As a web-based platform, any user that requires access to the system can do so with a supported web browser and secure internet connection. Therefore, members can access the system via the embedded Member Portal.
MedHOK’s Member Services Management (MSM) solution is an actionable repository for issues and inquiries where many different data sets can be seamlessly accessed and organized in a single interface, creating one view of a member’s demographic, transactional, and other relevant information. MedHOK’s MSM provides users with the ability to manage and analyze member issues and inquiries with real time reporting tools, including standard reports, a business intelligence tool, and dashboards.
MedHOK’s MP (MarketProminence) Financial Reconciliation module comes out-of-the-box, fully compliant with CMS Medicare and state Medicaid rules and can be easily configured to meet health plan-specific business requirements. This solution is offered as an add-on module for MP Enrollment, providing the most rigorous system in the industry to ensure compliance and timely processing for enrollment reconciliation and billing procedures.
MedHOK's MP (MarketProminence) enrollment and eligibility solution streamlines the enrollment process into Medicare Advantage, Medicare Part D Prescription Drug Plans, and Prescription Drug Plans. The enrollment functionality enforces CMS’ regulations regarding data capture and keeps Medicare Advantage/Medicare Advantage-Prescription Drug organizations and Prescription Drug Plan Sponsors in compliance using sophisticated tracking and audit capabilities.
Communicating with potential members requires regulation compliance. MedHOK MP (MarketProminence) solution provides tracking and monitoring of marketing and sales activities to ensure compliance with CMS guidelines and measure campaign effectiveness. These activities might include:
Another functionality of MedHOK's MP (MarketProminence) component of the Unified Payer Platform is Premium Billing. This functionality offers:
Manage all grievances across the organization with this CMS-compliant structured workflow component of MedHOK's Unified Payer Platform.The Grievances functionality allows you to:
MedHOK’s Complaints Tracking Module (CTM) is used to process complaints about dissatisfaction with any aspect of the operations, activities, or behavior of a health plan or its providers. Customers use this solution to respond to complaints made directly to CMS by the members or representatives; provide resolution to CMS within specified timeframes; and communicate with internal and external business partners to ensure the complaint is investigated thoroughly.