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Government Programs Consulting

Expert consulting services for payers and providers that want to launch or expand Medicaid, Medicare, and Medicare Advantage lines of business.

 

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Engageour Medicaid and Medicare Consulting Team

  • Select the right business lines and products to succeed in an evolving marketplace.
  • Develop a provider network to support new care and payment models.
  • Maintain regulatory compliance and prepare for audits.
  • Engage our experts to write policies and procedures, and to handle training and implementation for special-needs plans, Medicare- and Medicaid-aligned incentives, and dual demonstrations.
  • Achieve high CMS Star ratings and quality health outcomes.
  • Design and implement a rigorous special investigations unit to help identify, remedy, and prevent fraud, waste, and abuse.

Build Successful Government Healthcare Programs

  • Medicare and Medicare Advantage Consulting

    Our team’s leadership, guidance, and support helped payers launch new Medicare lines of business that achieved 4+ Star ratings from CMS. We’ve supported Special Needs Plans, Dual Enrollment programs (D-SNP), start-ups, and more.

    Our team supports:

    • Medicare Operations 
    • Compliance Program Effectiveness Audit
    • Program Audit Support and Remediation
    • Mock Program Audits
    • Delegation Oversight
    • MAPD and DSNP Markey Entry
    • Stars Program Improvement
    • Interim Staffing
    • CMS, MAPD, and DSNP Training
    • Model of Care
    • New Plan Application Support
    • Training
    • Customer Service

  • Medicaid Consulting

    Our team has more than 30 years of experience helping payers launch and grow Medicaid plans.

    Our team supports:

    • Staff training
    • Customer Service
    • Readiness Review Preparation
    • Interim Staffing 
    • Mock Program Audits

  • Medicare and Medicaid Provider Consulting

    Our team assists with:

    • Provider Support
    • Revenue Cycle Management Operations
    • Value-Based Contracting

Our outcomes

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Case Study

Payer Shines in CMS Program Audit with Help From Government Health Plan Audit Services

Case Study

Payer Shines in CMS Program Audit with Help From Government Health Plan Audit Services

Learn how Change Healthcare’s Government Programs Consulting practice supported a regional payer in their efforts for a very successful CMS audit.

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Case Study

Payment and Revenue Integrity Assessment

Case Study

Payment and Revenue Integrity Assessment

Discover new opportunities by engaging in a third-party payment and revenue integrity assessment, which can lead to revenue recovery and stronger processes.

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Infographic

Healthcare Consulting Core System Replacements

Infographic

Healthcare Consulting Core System Replacements

Discover 10 guidelines for your next core system replacement process via our tenured healthcare-consulting experts.

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We appreciate your interest in Change Healthcare. A member of our team will contact you to better understand your needs and discuss potential solutions.

Together, we are accelerating the journey toward improved lives and healthier communities.