Cúram for Medical Assistance

Cúram for Global 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 Global 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 Global Medical Assistance delivers a comprehensive set of business processes, rules, and evidence.  When used along with other CGISS components, Cúram for Global 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 Global 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
• Evidence entities, rules and processes to support the specific mandates of the Affordable Care Act - including expanded Medicaid eligibility and determining eligibility for insurance subsidies
• 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

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