Home Care Ancillary Services

Our Home Care Ancillary Services cost reduction offering partners with health plans to provide their members with high quality, patient-centered, “high-touch” care through the coordination and management of home care ancillary services such as Durable Medical Equipment & Supplies, Home Health, Home Infusion, and post-acute transition of care.

Catalyst can help:

  • Significantly lower PMPM
  • Encounter Reporting
  • Reduce of Fraud, Waste, & Abuse
  • Improve Provider Contracting, Reporting, & Scorecards
  • Electronic Visit Verification for Home Health Providers
  • Improved Care & Effective Utilization Management
  • Member & Provider Process Improvement
  • Access and Availability to Providers
  • Increase Member & Provider Satisfaction

High Cost Pharmacy Cost Reduction

The focus of Catalyst’s Specialty Pharmacy cost reduction offering is on eliminating waste in both the pharmacy and medical benefits using state of the art technology designed specifically for high cost pharmacy cost reduction. Catalyst’s program uses place of service (home infusion vs infusion centers), prior authorizations, medical claims editing and identification of duplicate claims, and fee schedule review to drive significant savings to the health plan.

Catalyst’s program provides:

  • High-cost injectable drug substitution for lower cost, equally effective drugs; while achieving significant cost reduction and having excellent outcomes.
  • Integrating Pharmacy Benefit & Medical Benefit.
  • Analytics that incorporate Business Intelligence, Intervention Programs, & Program Monitoring.

Member Disability Classification

Catalyst’s Disability Identification and Conversion offering assists in identification of Medicaid members who qualify for disability/ABD status and conversion of those members to a higher PMPM designation. This reclassification also allows for monthly income for the member and access to other programs. The focus of this offering is to bring substantial new bottom line revenue to the MCO by ensuring members who are disabled are properly classified as such (ABD/SSI), bringing significantly higher PMPM to the plan. Additionally, the member receives monthly, tax-free income by being on Social Security Disability which greatly aids the Social Determinants of Health and can lower healthcare costs and create healthier members.

Catalyst can:

  • Identify high-cost, chronically ill TNF/ACA expansion members.
  • Reclassify those members to higher PMPM categories through Federal and State programs.
  • Connect members with programs that impact social, economic, and material factors surrounding their lives-housing, education, availability of nutritious food, employment, and social support, all with significant impact on health outcomes.

Payment & Premium
Accuracy Optimization

Payment and premium integrity are complex issues compounded by ever changing information coming from multiple sources.

Premium integrity is a service offering that focuses on Medicare Secondary Payer (MSP) populations and their associated capitated premiums, paid by the Centers for Medicare and Medicaid Services (CMS) to Medicare Advantage (MA) plans. Experience has shown that MA plans struggle to identify and manage these member populations, as it relates to maintaining complete and accurate premiums due to a number of disruptive factors in the market.

Catalyst’s payment integrity is a solution that gives health plans the ability to effectively coordinate benefits for Medicare members by significantly reducing overpaid claims and limiting compliance risk with CMS. The integration of information gained through the Mandatory Insurer Reporting under section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) reporting is used to help identify Medicare entitled members that often go unidentified by the plan.

Catalyst Can:

  • Recoup any underpaid capitation and identify under/overpayments by focusing on Medicare Secondary Payment populations.
  • Offer provider reconciliation solutions and methodologies to help payers navigate Medicare Secondary Payment populations and the associated capitated premiums paid by CMS.
  • Limit compliance risk with CMS.
  • Improve accuracy of claims processing.
2353 S/b Broadway. Denver, Colorado. 80210
303-393-8818 | 800-903-9574 | 303-393-8838