Optimize Medicaid Program Performance with Data-Driven  Solutions

Elevate Program Integrity, Reduce Fraud, and Deliver Exceptional Care
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Managing a Medicaid program in the United States requires navigating a complex web of challenges, from detecting fraud and preventing waste to ensuring enrollment data is accurate and up to date.

With LexisNexis® Risk Solutions, you can harness the power of advanced data analytics, seamless automation, and expert insights to simplify program operations, protect resources, and ensure your members receive the healthcare services they need. Our solutions enable Medicaid and Medicare decision-makers to bridge gaps, build trust, and drive sustainable program efficiency.

Why Medicaid Programs Choose LexisNexis® Risk Solutions


Advanced Technology to Solve Critical Challenges:

360-Degree Visibility

Gain a comprehensive view of providers and beneficiaries with unparalleled data linkage capabilities.
Proactive Fraud Prevention

Safeguard programs against sophisticated fraud schemes using advanced identity verification and network analytics.
Data Accuracy and Completeness

Ensure every decision is based on clean, current, and actionable data points captured in real-time.

Proven Benefits

Save resources and taxpayer dollars by reducing improper payments and duplicate enrollments.

Improve care delivery through whole-person insights and better coordination.

Enhance transparency and regulatory compliance with accurate reporting tools.

Achieve Improved Medicaid Outcomes

Navigating Complex
Data Silos:

Medicaid and Medicare data are often stored across disparate systems, making it difficult to connect and analyze. This fragmentation limits agencies’ ability to understand the full scope of a beneficiary’s needs.

Preventing Fraud, Waste, and Abuse:

Fraudulent activities like identity theft, false billing, and synthetic identities continue to threaten program integrity. Without modern fraud detection and prevention tools, addressing Medicaid fraud and Medicare-related schemes can be overwhelming.

Managing Changes in Eligibility:

Real-time changes like in-state residency shifts, deceased beneficiaries, or inaccurate Social Security records often result in improper payments unless tracked and updated promptly.

Optimizing Resources Efficiently

With limited budgets and increasing demands, agencies must find cost-saving strategies to allocate resources effectively while ensuring oversight and compliance.

Unmatched Data Capabilities:

Our proprietary technologies, such as LexID® and Scalable Automated Linking Technology (SALT), create a unified profile of individuals and providers, making it easier to detect connections, patterns, and gaps.

Fraud Detection and Prevention Tools:

By leveraging network and relationship analytics, agencies can uncover non-obvious Medicaid fraud attempts such as shell companies, hidden ownership, and false provider identities while strengthening Medicare fraud prevention as well.

Eligibility Monitoring:

Solutions like residency validation, deceased checks, and Social Security cross-references ensure accurate capitation spending and compliance with Medicaid Services requirements.

Whole-Person Insights:

Connect healthcare, socioeconomic, and behavioral data to address broader health disparities and improve population health outcomes, while supporting oversight and program integrity.

Enhanced Integrity:

Reduce Medicaid fraud, waste, and abuse by identifying and preventing risks before they impact program funds. Expand fraud prevention strategies to Medicare oversight for broader program integrity.

Better Member Care:

Use consolidated insights to ensure continuity of care, closing gaps in service delivery for Medicare and Medicaid beneficiaries.

Improved Operational Efficiency:

Replace manual, resource-intensive workflows with automated tools that streamline eligibility determination and support fraud investigation processes across both Medicaid Services and Medicare.

Confidence in Compliance:

Achieve regulatory alignment with HHS standards and reduce the risks associated with audits, OIG oversight, and reporting inaccuracies.

 

Discover How to Optimize
 Medicaid Management
 See the difference LexisNexis® Risk   Solutions can make for your Medicaid
 and Medicare programs.

 

 

See the difference LexisNexis® Risk Solutions can make for your Medicaid and Medicare programs.

Contact Us Today to Request a Demo

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