MDwise Streamlines Business Operations to Improve Provider and Member Experience

1/3/2019
 
To improve the health care experience for its members and providers, MDwise will bring claims processing in-house beginning Jan. 1, 2019.
 
“We will have more control over the claims processing functions by performing the functions in-house,” said MDwise CEO Bruce Hayes. “This change will allow us to promptly and accurately pay our providers for the high-quality services they provide to our members. It also helps us attain our goal of improving the health status of our members through the most efficient provision of quality health care services.”
 
MDwise will use a platform called HealthRules to integrate its claims and membership system. McLaren Health Care, which acquired MDwise last year, has used the platform for five years. It has allowed McLaren to pay 97 percent of claims within seven days.
 
“I communicate with providers on a daily basis about outstanding claims,” said Cynthia Tate Gardner, Director of Claims Management at MDwise. “Bringing the process in-house will minimize stress for our providers and members.”
 
“We think that this change in claims processing will positively impact our providers and the MDwise members who choose Eskenazi Health,” said Dan Sellers, CFO of The Health & Hospital Corporation of Marion County, the municipal corporation that operates Eskenazi Health.  “We have worked with MDwise to provide Hoosiers with quality health care for 24 years, and we look forward to continuing that relationship.”
 
Member coverage will not be disrupted by the change in claims processing.

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About MDwise

MDwise is an Indiana-licensed nonprofit health maintenance organization offering health care benefits to more than 300,000 Medicaid members. Since 1994 MDwise has provided access to compassionate, high-quality, coordinated health care and education to Medicaid members in communities across Indiana.
 
MDwise is a provider-owned health plan with a large network of doctors, specialists and hospitals located throughout the state. By meeting the basic requirements of the National Committee for Quality Assurance’s (NCQA’s) rigorous standards for consumer protection and quality improvement, MDwise was awarded NCQA’s accreditation status of Accredited for service and clinical quality.

Ninety-seven percent of MDwise members surveyed would recommend MDwise to their family and friends, a rating that helped the organization earn a Gold Stevie Award for customer service in the 2018 American Business Awards. For more information, visit MDwise.org.