Administrative Services Organization Medicaid
Using an Administrative Services Organization to Reform Your Medicaid Program Many states are eager to reform their Medicaid programs by implementing “flexible benefit packages” and other managed care reforms that are allowed under the federal Deficit Reduction Act (DRA). However few states have the health care management infrastructure that is needed to administer such a program. To implement these innovative new “managed” Medicaid fee-for-service programs, Medicaid agencies have begun to contract with private companies to provide managed care and health plan administration services. While this type of company is generally referred to as an Administrative Services Organization (ASO), they can also be referred to as a Third Party Administrator (TPA) or Medicaid Administrative Agent (MAA). These companies are capable of applying administrative services functions
and all of the clinical management tools of the managed care industry, including care coordination, case management, disease state management, health plan benefit administration, utilization review and nurse triage call centers, to administer and manage fee-for-service Medicaid programs—but on a non-capitated basis.