Operational consulting


  • Print
  • Connect
  • Email
  • Facebook
  • Twitter
  • LinkedIn
  • Google+

Milliman healthcare consultants with clinical, IT, operational, compliance and marketing backgrounds, coupled with in-depth knowledge of Medicare Advantage programs, provide the full spectrum of services to support Part C and Part D plan sponsors in operating their plans.

Operations

Milliman reviews organizations' operations for effectiveness and compliance with the Centers for Medicare and Medicaid Services (CMS) and/or state requirements, including staffing levels, risk score optimization, marketing/sales and IT capabilities. Milliman also benchmarks administrative costs and efficiency.

Compliance

Operations and compliance go "hand-in-hand." Milliman compliance experts help assess and optimize compliance by conducting mock audits, including educating, training and coaching staff and preparing audit samples. Milliman evaluates and recommends improvements for compliance programs, compliant operations, delegation oversight, corrective action plans, policies and procedures and continuous internal surveillance processes.

Healthcare management

Milliman's clinical consultants help minimize inappropriate benefit expenses by assisting with building and/or evaluating internal and vendor healthcare management programs to achieve best practice in prior authorization, concurrent review, retrospective review, demand management, case management, disease management and wellness functions.

Data validation

Milliman has a Medicare Advantage data validation team capable of conducting independent data validation audits. CMS will require all Part C and Part D organizations to engage a "data validation contractor" to conduct an independent audit of certain 2010 reporting data sometime between March and May of 2011.

Next steps