Health Plan Solutions

Our Approach

As a quality, care and revenue management solutions partner, Altegra Health empowers Managed Medicaid, Medicare, and Commercial health plans to integrate key areas of financial performance and continuity of care while improving the quality of life of the individuals they serve.

Our solutions enable health plans to gain a deeper understanding of their members and provider networks in order to bring together the right benefits, the right care, and the right reimbursement. We achieve this through a comprehensive and integrated approach to member engagement, quality reporting, and risk adjustment programs. We also offer a full line of advisory service solutions to health plans to help improve their claims adjudication processes, maintain regulatory compliance, and detect and prevent fraud, waste & abuse.

Product Segments and Solutions:

Risk Adjustment & Audit

Continuous monitoring and reporting of risk scores to ensure members are appropriately risk-adjusted and, in turn, qualify for appropriate payment.

Quality Performance

Our Quality Performance solutions provide continuous member engagement and quality measurement tools to ensure appropriate and satisfactory levels of care. They include:

Engagement Solutions

We combine the latest technology with live Advocates and clinicians to assess for and educate members’ preventative care and chronic illnesses, facilitate provider office and home appointments, help remove socioeconomic barriers to care and facilitate annual certification for Medicaid dual eligible related programs.

Advisory Services

From contemplation to execution, Altegra Health is a valued advisor to a number of the nation’s most prominent health systems and health law firms.