Outcome Measurements
Information Management & Support
A Systems Approach
In Practice
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CareManager® Modules
Enrollment
Basic client information is recorded for billing and management reporting.
Assessment
Assessment data is gathered and stored, including baseline behaviors, client strengths and needs, cultural issues, diagnosis, and other relevant assessment information.
Plan of Care
Used by care managers to document individualized treatment plans they develop in conjunction with clients, families, and professional team members. The emphasis is on integrated, culturally competent plans that utilize client strengths, and organize a support system that includes family, community, and professionals.
Planned Actions
Allows system managers and supervisors to review monthly service authorizations, and monitor the appropriateness, utilization and cost of services in a timely manner, as well as ensure prescribed services are consistent with treatment goals.
Progress Notes
Allows care managers and care providers to enter progress notes and review those of others to ensure a coordinated, integrated plan, as well as to ensure that services authorized are being provided.
Claims Adjudication
Claims are approved or denied, based upon prior authorized plans. The adjudication process automatically generates remittance advice and explanation of benefits reports.
Financial Management
After the claims adjudication process is complete, revenue and expenditure information can be transmitted to accounts receivable, and accounts payable, and general ledger systems.
Electronic Third-Party Billing
Claims Adjudication and Financial Management modules can be adapted to fit the specifications for electronic claims submission for third-party reimbursement by Medicaid, private insurance, and other payers.