The North Carolina Department of Health and Human Services’ Healthy Opportunities Pilot Program (HOP) recently implemented the ability to verify member eligibility within the Unite Us closed-loop referral platform. Care managers can link Medicaid information to a person’s record to receive automatic notifications about their Medicaid eligibility status.
This not only helps facilitate social care, but also ensures that Medicaid members quickly address gaps in coverage, according to Unite Us. The company said it is the first social care technology solution to integrate real-time member eligibility verification with closed-loop referral management through X12 EDI 270/271 transactions.
HOP was established to test and evaluate the impact of providing select evidence-based non-medical interventions related to housing, food, transportation, and interpersonal safety to high-needs Medicaid enrollees.
North Carolina DHHS is also building a statewide coordinated care network (NCCARE360) to electronically connect those with identified needs to community resources and enable a feedback loop on the outcome of that connection.
“The Healthy Opportunities Pilot Program is the first innovative program of its kind that is described as ‘life-changing’ for thousands of North Carolina families,” María Ramírez Pérez, associate director of Healthy Opportunities, said in a statement. “HOP’s success is a product of collaboration with partners in the healthcare, social support and technology sectors. The ability to integrate our Medicaid Management Information System (MMIS) with Unite Us has improved our reimbursement workflow when verifying Medicaid eligibility. As we were looking for efficiencies and time savings for our system’s care managers, the integration of our MMIS was a big win.”
“By leveraging this functionality, we can now allocate HOP resources more efficiently and effectively, ensuring Medicaid members receive the support they urgently need in critical areas such as housing, food security, transportation, interpersonal safety, and stress mitigation. “This builds on the long-standing partnership between HOP and Unite Us, underscoring our commitment to providing targeted assistance where it matters most and ultimately improving health outcomes and fostering stronger, more resilient communities.” Perez added.
The functionality is based on Unite Us Payments, an integrated capability that enables reimbursement for social care services at scale from the referral platform, to further streamline the reimbursement process for community-based organizations (CBOs) and providers delivering services. .
Several states rely on the payment solution as a key infrastructure component of their Medicaid initiatives, including Oregon, where nine coordinated care organizations are currently using payments to streamline Medicaid billing for community-based organizations under their climate benefits program. for health-related social needs.
“This new integration is an important milestone in our mission to expand access to vital social services,” Raffaelle Breaks, chief product and technology officer at Unite Us, said in a statement. “With Unite Us Member Eligibility Verification, we give care managers the ability to verify Medicaid eligibility prior to enrollment, ensuring timely support for beneficiaries and a more efficient workflow for care managers. attention”.
