Maximize Reimbursements
Streamline Workflows
Reduce Penalties
Mitigate Risk


Your Medicare Advantage, Managed Medicaid, and ACA Compliance
& Operational Solution
All In One Place


Effortless CMS Compliance
Turn-Key Solution
for Start-Up Health Plans

Leverage Our Expertise

Dynamic Healthcare Systems provides Member Management and Risk Adjustment Solutions to Managed Care Organizations participating in Medicare, Medicaid, and Exchange programs. Partnering with Dynamic will help your Managed Care Organization Optimize Revenue, Streamline your Operational Processes, and Increase Efficiency while remaining Focused on CMS Regulatory and Compliance Requirements. 

Enrollment – Eligibility

Consolidate multiple systems and processes into a single solution with best practices to meet all CMS regulations. Dynamic’s automated enrollment solution  utilizes extensive pre-submission validations resulting in reduced manual labor, simplified enrollment status checking, highly accurate enrollment processing, and the identification of secondary payers. Generate all the correspondence needed during the election, enrollment, and premium billing processes to meet all CMS requirements.

Revenue Reconciliation

Helps plans optimize revenue by highlighting and prioritizing discrepancies between plan data and CMS data including special statuses, demographic information, and risk scores. Easily load membership, bid information, and MMR to quickly identify member, special statuses, and payment discrepancies to streamline the attestation process. Oversight services to optimize revenue at the member level taking into consideration demographics, special statuses, LEP, LIS, LIPS, bid contract, and other factors.

Premium
Billing

Provides plans the tools to successfully manage the premium and dues billing process for their Medicare members. Supports multiple billing schedules, various payment methods, the inclusion of a delinquency process based on CMS guidance, the integration of up-to-the minute member subsidies, and Late Enrollment Penalties (LEP), as well as complete tracking of prospective and retroactive enrollment.

RAPS & Encounters

A comprehensive and feature rich Encounter Processing and Submission solution that prepares and submits RAPS and EDS data to CMS. Our solution effectively handles EDS processing from Preparation through Submission, to reject handling, and includes all levels of HIPAA validations, along with status dashboards for transparency and audit every transaction. RAPS to EDS reconciliation Reporting inclusive in the solution.

HCC Analytics

Examine all source data to identify suspect, missing, or incorrectly coded diagnosis codes – the foundation of accurate Risk Adjustment Scores. Helps plans optimize CMS revenue by identifying missing or potentially incorrectly coded HCCs based on historical trends, DMEs, Rx, and other complex algorithms.

CMS Submission

Accurate CMS validations filtering logic and timely Enrollment, RAPS, and Encounters submissions to CMS with high expectance and avoidable reject rates. Dynamic has been a certified 3rd party submitter – an intermediary between payors and CMS, for the past 15 years, submitting transactions specifically for elections, RAPS and EDS, and COB- OHI.

Dynamic is pleased to support: