Saturday, October 8, 2016

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Administrative Aervices Organization Medicaid

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.

What Is An ASO Health Plan?

What Is An ASO Health Plan?

Self-funded health care also known as Administrative Services Only (ASO) is a self insurance arrangement whereby an employer provides health or disability benefits to employees with its own funds. It is an arrangement in which an administrative services organization funds its own employee benefit plan such as a pension plan or health insurance program but hires an outside firm to perform specific administrative services.

With a self-funded health plan, you pay for your employees' claims out of your own funds. ... With Regence ASO, all of the administrative duties and stop-loss.