PAYERS

States & Managed Care Organizations (MCOs)

One of the keys to effectively managing Long Term Supports and Services (LTSS) is ensuring home care services are delivered in accordance with care plans and authorizations. Sandata’s solutions automate the remote acquisition of service data by capturing time, attendance and visit information entered by the home care worker at the point-of-care. Our solutions are tightly integrated with scheduling, billing, payroll, and participant management functions. We offer key stakeholders (MCO Case Managers, State and CMS administrative users) jurisdictional oversight over ALL provider agencies delivering community-based LTSS.

Our solutions support a wide range of

community based care, including:

  • Waiver Programs including:
    • Private Duty Nursing
    • Skilled Nursing Care
    • Personal Care Attendant Services
    • Traumatic Brain Injury
  • Consumer-Directed Programs
  • Dual Eligible Programs
  • Home Delivered Meal Programs
  • Veteran’s Services

SANDATA BRINGS VALUE TO PAYERS

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Coordination of Care

  • Decrease facility utilization by ensuring timely community based care.
  • Reduce readmissions.
  • Import of discharge care plan and automated visit scheduling for community based LTSS.
  • Improved coordination, monitoring and management.

Fraud & Abuse Prevention

  • Minimizes time reporting errors through visit validation and custom billing rules that significantly reduce inaccuracies and potential abuse.
  • Ensures ONLY claims that match the authorization are sent to the payer; placing the burden on the provider to bill correctly the first time.
  • Supports program transparency and tightens audit controls by providing access to home care services data to effectively audit providers and conduct extensive post payment reviews on aberrant claims.
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Quality Management and Outcomes

  • Immediate, real-time verification of authorized services including documentation of caregiver identity, start and end of each visit, location of service delivery and the creation of an electronic timesheet and record of the visit.
  • Plan-of-Care and Point-of-Care data collection and reporting capabilities to efficiently and effectively collect quality metrics for community based LTSS.
  • Electronic alert options offer real-time notifications for late visits and missed appointments allowing stakeholders to react accordingly ensuring care plan compliance.
  • Member health status collection and alerting.
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Visibility

  • Home care providers and payers share a real-time composite view of authorized LTSS within their jurisdiction.
  • Business Intelligence and dashboard capabilities allow you to drill down to a more detailed level, create ad hoc reports, measure performance against benchmarks and provide additional project evaluation analytics.
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Provider Support and Services

  • Supports caregiver credentialing, compliance and caregiver matching to participant-specific attributes.
  • Creates an opportunity for home care provider operational efficiencies allowing more participants to be served.
  • Improves billing accuracy via consistent rules-based billing and scheduling software platform that ensures providers are reimbursed quickly for all services that have been verified.

Participant Safety and Satisfaction

  • Supports a participant-centric plan-of-care regardless of the original source of benefits.
  • Multiple alert options for missed / late visits and agency supervisory and payer jurisdictional monitoring in real-time triggers emergency back-up processes ensuring services are delivered as authorized.
  • Supports consumer-directed models with authorization spend down and Plan-of-Care prompting features to promote independence, improve quality of life and allow participants to remain in their homes longer.