Cúram for Medical Assistance
Cúram for Medical Assistance transforms and modernizes medical assistance and disability programs with a powerful, proven set of business tools and processes.
Suitable For:
- States that want to replace their legacy systems for medical assistance programs
- States that want to replace their siloed income support and medical assistance legacy programs with an enterprise solution
- Counties or municipalities that want to replace their legacy systems for medical assistance programs with an enterprise solution
Cúram for Medical Assistance is the only commercial off-the-shelf (COTS) integrated service delivery solution that equips organizations with a powerful, proven set of business tools and processes designed specifically for the effective management of medical assistance programs. Cúram for Medical Assistance supports multiple models of medical assistance including government subsidized insurance models requiring client payment of premiums. It integrates service delivery by allowing agencies to share evidence and business processes and determine eligibility across multiple programs and automates the complexities associated with eligibility and entitlement determination using pre-populated rule sets that can be easily appended and modified.
As an integral component of Cúram Global Income Support Suite (CGISS), Cúram for Medical Assistance delivers a comprehensive set of business processes, rules, and evidence. When used along with other CGISS components, Cúram for Medical Assistance enables organizations to efficiently screen clients, automatically determine eligibility, and integrate service delivery for multiple needs-based programs, including income, food, and medical assistance. Cúram for Medical Assistance integrates seamlessly with other solution components for an enterprise wide solution providing holistic service delivery, integrated case management, service planning, and financial and provider management.
- Included evidence entities, rules, and business processes for mandatory U.S. Medicaid coverage groups, as well as optional programs, such as Long-Term Care, Refugee, Emergency Medical Assistance, and Breast and Cervical Cancer ensure the correct application of complex eligibility policies
- Provisions for complex processing including processes for Children’s Health Insurance Program (CHIP), spend-down, Long Term Care and retroactive eligibility ensure accurate results and complete coverage across medical assistance programs
- Cascading eligibility allows administrators to set program hierarchy and prioritize programs and allows for single or multiple program eligibility results to deliver the optimum benefits to clients based on their unique circumstances
- Integrated verification and evidence management tools ensure the accuracy of client information
- Change-in-circumstance processing supports retroactive changes in data and automatically reassesses client benefits
- Eligibility summaries and budget sheets guide new workers through decision analysis and display details on how eligibility is determined for medical assistance coverage groups
- Cúram’s extensive administrative and development tools allow agencies to easily configure and extend the solution, speeding deployment and simplifying maintenance
- Software built specifically for human services and social services
- Domain specific business content (rules, evidence, business processes) OOTB
- Outcomes based and client focused
- Provides a framework for agencies to collaborate for the best outcomes
- Enterprise Approach – not a siloed/single program approach
- Allows for Incremental Modernization and Transformation (IMT approach)
- Market Leader and Thought Leader in SEM arena
Supporting Materials
“It became very clear that outsourcing to an experienced vendor with substantial resources and state-of-the-art technology created specifically for the human services industry was the fastest and most efficient way to modernization success.”
Zach Main, Director State of Indiana’s Division of Family Resources