Medicare Advantage Services

Medicare Advantage Services

A large percentage of the AHS client base is Medicare managed care (Medicare Advantage) covering approximately 2,500 lives in Medicare Advantage institutional or community special needs plans. Approximately 70% of the covered lives are based in Arkansas with the remainder of the lives spread across 3 other states. 

The care application and support infrastructure used by AHS has a vast amount of managed care built within its operation.  The service meets client needs related to IT Applications, Compliance, Infrastructure, Security, Hosting, Business Processes and Service Desk. Through these services we ensure clients can keep pace with ongoing reforms and regulatory mandates. Our service excellence, critical to client success, is the result of 25+ years of experience in providing services that include:

Claims Administration (Claims data intake / Clearing house convergence / Claims adjudication / Prior authorization / Fraud and abuse / Payment & print distribution / Claims overflow BPM/workflow)

Medicare Medical Management (Health Risk Assessment, clinical assessments, complex case management / Medicare Care Management platform for integrated clinical programs /case management)

Medicare Back-Office Operations (Membership and enrollment / Premium billing and reconciliation / Member and provider services / Membership scanning and fulfillment / Claims – EOB, check, correspondence printing)