With the unexpected double-digit growth in Medicaid enrollment these past few years, it’s been a challenge for states and MCOs to assure access to appropriate dental care and oral health equity for all members. Scaling up membership quickly and expanding benefits is tough when a Medicaid program is being managed with manual and paper-based processes.
In contrast, SKYGEN’s technology-enabled approach to specialty benefits is driving results for states and MCOs that have modernized Medicaid administration with us. During the economic shutdown SKYGEN rapidly implemented 60 emergency workflow adjustments to help our clients navigate the challenging new landscape. We’ve also helped MCOs respond quickly to requests by their clients to put increased benefits in place that ensure all members have the opportunity and ability to access quality dental care.
Expanded Medicaid Benefits Success Story
When the State of West Virginia expanded Medicaid dental benefits on select services for adult beneficiaries, two MCOs partnering with SKYGEN wanted to deliver for their client quickly. With SKYGEN’s enhanced benefit configuration and flexible claims automation, SKYGEN rolled out full functionality on the additional benefit to members of both plans in less than 30 days.
To ensure members do not incur any out-of-pocket expenses, the state requested prior authorization on all expanded benefit services except for the periodic exam, initial comprehensive exam, and comprehensive periodontal evaluation. SKYGEN met this request, and added an accumulator by setting the maximum benefit dollar amount with a yearly period for the codes that make up the expanded benefit. As claims are processed the member’s accumulator balance is updated. Payments to the provider end once the maximum amount is consumed.
Members have several ways to easily check their balance, including through SKYGEN’s Member Mobile app, the Member Web Portal, and by contacting SKYGEN’s Call Center. Providers can also check member balances through the Provider Web Portal. Our MCO partners are already seeing early returns on the desired outcomes of better overall consumer experiences and increased member satisfaction.
30-Day Transition to TPA Success Story
With a rapidly changing Medicaid environment, in-house benefit program management can run into unexpected challenges. That was the case for another MCO that also works with the State of West Virginia. After two months of managing the expanded Medicaid dental benefits program, this MCO realized it wasn’t able to perform as planned. SKYGEN was asked to take over administration of this program. We made this transition smoothly within 30 days.
SKYGEN has comprehensive digital strategies and tools to that enable our partners to respond effectively and with far less friction to increases in membership and new market opportunities. By reducing cost and providing innovation like the Medicaid Member Mobile app as well as flexible plan design, SKYGEN helps Medicaid programs establish stronger connections with members and implement strategies that improve access to quality care.
Moving Oral Health Equity Forward with SKYGEN
SKYGEN’s digital approach aligns people, processes and technology to support MCOs in advancing oral health equity goals. The pandemic exposed what Medicaid program administrators have known all along – that vulnerable people suffer the most in times of economic stress. Today, due to record Medicaid enrollment, MCOs are having a greater challenge to ensure everyone has access to appropriate dental care and oral health equity. Learn how our automation and flexible strategies can offer greater access to dental care.