Tip Sheets
5 Best Practices for Retaining and Engaging Your Members Amidst Redetermination
The unwinding of the Medicaid continuous enrollment provision is a stressful and complex process, but it’s critical that health plans empower, engage, and retain members throughout the initiative.
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Fact Sheets
SNP Complex Case Management
Health plans face unique challenges in providing high-quality care to members with complex needs. Building a comprehensive model of care for Special Needs Plans (SNPs), including Dual Eligible Special Needs Plans (D-SNPs) and Chronic Special Needs Plans (C-SNPs), is a significant achievement.
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Case Studies
D-SNP Product Design & Delivery
A 400,000-member government program-focused managed care organization, part of a world-renowned integrated care delivery system, sought to expand its product offerings and introduce a Dual Special Needs Plan (D-SNP) in the state. It turned to Clearlink’s government program design experts to provide end-to-end design and delivery capabilities to implement the new D-SNP product.
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Checklists
5 Steps for a Successful SNP Model of Care Submission
The Model of Care (MOC) must be built on evidence-based practices, must demonstrate your health plan’s ability to provide high-quality healthcare services to vulnerable populations, and must describe your approach to care coordination, member engagement, and other key areas. Achieve smooth SNP MOC preparation, submission, and approval using a handy checklist.
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Blogs
Best Practices for Submitting Your SNP Model of Care
If your organization is preparing for annual Model of Care submission, it’s crucial that your team accurately interprets regulatory requirements, prepares well in advance, undergoes training and education, and understands the operational aspects of running a Special Needs Plan (SNP).
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Blogs
5 Strategies for Streamlining Prior Authorization in Managed Care
While prior authorization (PA) helps improve quality with cost control measures, it often creates administrative burden and delays for providers. To address these concerns and optimize care delivery, managed care organizations must streamline the PA process.
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