What does CPS stand for?

That meant identifying, and then selecting, a system to consolidate IT processes and create a more fluid claims processing system.

This core system could be designed to fully incorporate the common components that each state's Medicaid claims processing system already includes, and its design will allow for ready adaptation and refinement to incorporate state specific policies and priorities.

Recommendation: To establish an effective fraud prevention system for the Medicaid program, the Administrator of CMS should evaluate our findings and consider issuing guidance to the state programs to provide assurance that effective claims processing system are in place to periodically identify both duplicate enrollments and deaths of Medicaid beneficiaries and to prevent the approval of claims when appropriate.

Sometimes, all your claims processing system needs is a simple upgrade or the addition of a new component.

Unlike the enterprise version, which requires integration with a healthcare insurance plan's multiple claims processing system, the lite version requires no such integration.

CMS implemented changes to its claims processing system that included a new edit against an existing discharge or transfer claim where the patient status code submitted on the existing discharge or transfer claim does not match the incoming admission claim.

Typically, the pattern one sees is that a series of claims are altered or modified or denied through an automated claims processing system, and then when you appeal those claims, that's when they ask for medical records, which further delays the payment.

8 million monthly Medicaid claims are being processed through the new system created by Electronic Data Systems (EDS), the vendor the Oklahoma Health Care Authority chose when it decided to build a new claims processing system from the ground up.