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Program Readiness

Healthcare is about helping people.

And when it comes to people—managing security, data privacy and risk is a major priority. Healthcare organizations need to ensure that program readiness requirements are met and the right people, processes and technology are in place so you can focus on your primary goal—providing exceptional quality care.

Whether it’s the development of your quality improvement (QI) program or responding to security events, TEKsystems can help you identify any gaps and achieve improvement benchmarks. We help you create new and optimize existing applications and report builds to meet regulatory requirements for data capture and reporting.

We specialize in delivering comprehensive teams of skilled resources and supporting complex program implementations to help you integrate with agencies, health plans, providers and other entities—and develop an infrastructure that will ensure collaboration over the long term.

TEKsystems provides the people, processes and tools needed to maximize quality outcomes, such as:

  • Comprehensive readiness evaluation and review of state or federal readiness tools
  • Advisory, review and development of document submissions
  • Evaluation of deficiency reports and management of required corrections
  • Extensive on-site mock audit review and readiness preparation, including interviews and system demonstrations for claims, care management and pharmacy
  • Evaluation of contract and implementation strategies
  • Programmatic implementation testing and contract compliance
  • Detailed assessment of quality, care management and model of care programs
  • Extensive system and data analysis, integration and report builds
  • Execution of operational activities

Supported Technology

  • Care management/coordination
  • Claims/configuration
  • Data warehouse/governance
  • Enrollment/billing
  • Fraud/payment recovery
  • Health information exchange / EHR
  • Member services
  • Pharmacy benefits
  • Privacy / information security
  • Program integrity
  • Provider contracting / data integrity
  • Quality/accreditation
  • Regulatory reporting
  • Risk adjustment / revenue cycle
  • Utilization management
  • We are experienced with all major regulators and regulations, including, but not limited to:

  • Centers for Medicare and Medicaid Services (CMS)
  • Department of Health and Human Services (HHS)
  • Health Insurance Portability and Accountability Act (HIPAA)
  • Managed Care Federal Regulations (42 CFR Part 438)
  • National Association of Insurance Commissioners (NAIC)
  • National Committee for Quality Assurance (NCQA)
  • Office for Civil Rights (OCR)
  • Office of Inspector General (OIG)
  • State Medicaid agencies
  • The Health Information Technology for Economic and Clinical Health (HITECH) Act
  • The Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
  • Title XXI of the Social Security Act—State Children’s Health Insurance Program (SCHIP)
  • Utilization Review Accreditation Commission (URAC)
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