CNSI’s enterprise solutions and customizable IT products drive real technological and business transformation for a number of diverse markets. Our commitment to public service and to our client’s success spans two decades. The markets we serve include:
CNSI is an industry leader in developing, implementing and operating cutting-edge technological solutions that modernize state Medicaid Management Information Systems (MMIS). We were the first in the nation to implement a web-centric MMIS and an integrated social services provider enrollment system. CNSI continues to address the many challenges that exist in the state Medicaid landscape, including the highly-impactful opioid epidemic and the ever-evolving question of modularity.
Federal health care agencies must deliver on their vision of health care quality, access to coverage, healthy outcomes, force readiness and population health while also lowering the cost of payment, delivery, and IT infrastructure. CNSI stands at the ready with our proven solutions and products that enable automation of health care administration processes. Our low-risk, rapid deployment solutions range from business transformation to claims and encounter adjudication systems to mobile applications. Our solutions are engineered for performance at every level of the systems architecture. CNSI’s deep health IT domain expertise is validated by our recent contact wins with the following federal and state health agencies.
Solutions & Products
Not every company can say it changed an industry, but we can. At CNSI, we continue to revolutionize the way we manage health care through technological innovations, which include cloud-based systems that provide for more efficient processing of medical claims, cutting-edge technology that can eradicate improper billing and waste and mobile applications that provide easy access to health benefits.
Here is our suite of enterprise Health IT Solutions & Products that increase programmatic efficiency and drive business value, leading to better care, better health and lower costs.
With states under tremendous pressure to modernize and develop more effective Medicaid IT systems that align with Centers for Medicare and Medicaid (CMS) modularity mandate, agencies are looking to streamline infrastructure while reducing implementation cost, time, and risk. Enter CNSI’s Next Generation Modular Delivery Platform, evoBrix XTM.
evoBrix XTM supports each State’s Medicaid Enterprise needs by enabling:
- Tenant-specific Configuration and Customization
- Reusable Business Functions
- Flexible Procurement and Implementation
- Utilization of a CMS-certified and federally compliant solution
Learn more about evoBrix XTM
by clicking here.
Processing platform designed specifically to meet the large-scale needs of Medicaid
eCAMS is CNSI’s Medicaid platform designed and tuned specifically to meet the volume and performance requirements of large-scale claims processing applications, with the flexibility to adopt new reforms, payment models and regulations while being mobile-ready allowing for seamless integration of digital health care ecosystems.
eCAMS provides end-to-end visibility into Medicaid organization and real-time monitoring and management of business operations. A fully services-oriented platform, eCAMS dramatically reduces total cost of ownership for state agencies by seamlessly integrating with industry-leading COTS products to leverage and increase the value of existing applications and systems.
Learn more about CNSI’s eCAMS platform here.
Comprehensive and Cohesive Project Management Platform
Assimilating and integrating fused Electronic Health Record data
CNSI’s Electronic Fusion Repository Management (eFRM™) and connected cloud services assemble a patient’s comprehensive, electronic health records (EHR) from multiple sources to improve health care delivery and patient outcomes.
Enabling terminology standardization from diverse EHR systems, eFRM™ is capable of assimilating and arranging data from various sources that generate administrative and clinical information for a patient. Not only does eFRM™ comprehensively store fused data; it provides a structured approach to arranging a patient’s clinical and administrative data in an analytical model, enabling a platform for data analytics.
To achieve the highest impact of patient safety and quality of care, patient information from across the health care continuum must be integrated and presented to clinicians at the point of care. eFRM™ supports creation of a Patient Health Record and leverages CNSI’s eFRM™ and cloud-based integration services along with a master person index, record locator service and an easy-to-use web viewer, providing patient data exactly when and where it is needed.
Learn more about eFRM™ here.
Solving eligibility, enrollment and casework on the cloud
Electronic Medicaid Eligibility Determination System (eMEDS) is CNSI’s solution for Medicaid modernization adaptation. It is a cloud-based eligibility determination, enrollment and caseworker portal solution that helps states address requirements for expanded coverage acquisition and access to a range of health care programs for citizens.
eMEDS, when implemented, drives benefits to both the citizens applying for coverage and states seeking to increase enrollment. Consumers will be able to submit their online application and enroll under a plan in real-time basis. This is a breakthrough in simplifying the entire coverage acquisition process for the citizens. Meanwhile, The Case Portal, being driven by business process workflows, is customized to accommodate state targets to ensure timely processing of Medicaid applications.
Extending Medicaid Connectivity for Managing EHR Incentive Payments
CNSI’s proven meaningful-use-certified Electronic Health Record (EHR) technology solution, eMIPP, is now taking the Medicaid program into the new age of connected healthcare infrastructure. eMIPP is a modular solution for managing the EHR Medicaid Incentive Payment Program (MIPP), Medicaid Health Record (MHR), and Health Information Exchange (HIE) connectivity. It offers a comprehensive and configurable solution to measure and demonstrate the EHR superior outcomes as outlined by CMS guidelines. This solution builds on the Medicaid Information Technology Architecture (MITA) principles and uses a services-based framework, thus enabling the solution modules to leverage and re-use existing state systems and quickly comply with Centers for Medicare & Medicaid Services (CMS) defined timeline.
CNSI’s eMIPP solution is built on a true services framework and can integrate with any existing MMIS system, HIE or other state system. The overall solution leverages a set of reusable services (provider registry, eligibility service etc.) to support state Medicaid agencies in administering the incentive payment program and meet federal audit and control standards.
The solution also provides an independent data set that combines clinical and administrative data sets;, leverages the open source CONNECT framework and integrates with external services like CMS’ National Level Repository (NLR) and the Office of the National Coordinator (ONC) to support and track the evolving requirements around meaningful use.
Transforming provider site visits
CNSI’s Site Visit Pro is a portable application that can be taken directly to provider sites to perform unannounced site visits. The application is mobile enabled for tablets, eliminating the need for paper forms. Additionally, it supports organizations in performing site visits using real-time provider information directly from the Medicaid Provider Enrollment system, eliminating redundant data entry.
The solution streamlines site visits by eliminating periods of no activity on the site visits through alerts to the appropriate state staff, decreases the time it takes to approve or reject a provider’s application for enrollment and eliminates redundant data entry and manual updates to the Medicaid Provider Enrollment system.
Streamlining Affordable Care Act provider enrollment screenings
CNSI’s Provider Credentialing Service (PCS) solution fulfills the Affordable Care Act’s mandated screening procedures for providers that want to participate in Medicare and state Medicaid programs. The PCS solution is comprised of pre and post-enrollment screening processes that integrate the system with a real-time credentialing service.
This one-stop solution provides improved automation and reduced manual intervention. Pre-enrollment screening results are available in real-time for the provider enrollment specialist to review and make appropriate decisions regarding approval or denial.
Through these advances, the solution creates cost savings due to process automation of screening procedures, integrates workflow solutions to provide improved automation and reduced manual intervention and helps state staffs conduct additional research and decision making.
Comprehensive and Cohesive Project Management Platform
As-One ES® is a one–stop solution for enterprise tool from CNSI, offering an array of modules to address the many aspects of project management. It is a web-based tool which provides a comprehensive and cohesive project management platform. As-One is packed with many capabilities to enable the customer to accomplish their delivery goals, giving the flexibility and ease-of-use across several modules.
- Risk Portal: The Risk module provides online interface for managing project risks including risk rating, risk assignments and risk tracking through its lifecycle.
- Action Portal: The Action Item module allows action item assignments in a collaborative setting to one or more individuals.
- Change Log Portal: Change logs can be used to document contract modifications, engineering change proposals and baseline changes.
- Work Products Portal: The Work Products module allows online tracking and management of formal (i.e. customer deliverables, product artifacts) and informal work products from inception through approval and beyond.
- Discrepancy Portal: The Discrepancy module is a complete tracking tool for tracking discrepancies in any form such as bugs, issues, deviations in work products, project deliverables or software systems.
- Events Portal: The Events module can be used to view events, such as milestone reviews, vacation time, meetings or teleconferences, in a monthly calendar, weekly calendar, daily calendar, or listing format.
Automate Business Processes from Fraud Detection to Recovery
Audit Studio is a web-based product with various user-friendly features that is designed to satisfy all the CMS Program Integrity certification requirements. Audit Studio, with its integrated Case Management capability, supports the overall fraud and abuse lifecycle from detection of potential fraud and abuse to creation of fraud cases to recoupment of excess payments. It also produces visualizations with drill-down capabilities and an integrated set of reports that provide utilization data for analyzing medical care and service delivery.
- Surveillance and Utilization Review System (SURS): SURS establishes standard utilization norms for providers and members and thereby tracks the providers and members who are most likely to be abusing the Medicaid program.
- Fraud and Abuse Detection System (FADS): FADS employs advanced statistical techniques to identify anomalous behavior of providers and members.
- Reporting and Analytics: For evaluation, Audit Studio can create standard and ad-hoc reports, dashboards and data visualization tools, a SURS/FADS data mart and COGNOS BI tools.
- Case Management: Audit Studio is capable of automated case initiation, built-in case activities, case workflow automation and workload management.
Robust, Automated Framework to Extract, Analyze and Report Data
eCAMS HealthBeat™ provides a robust, automated framework to extract, analyze and report data from diverse business processes into a centralized enterprise service view of MMIS systems, either by a web portal or through the tablet/mobile App. eCAMS HealthBeat™ enables near real-time access to workload and system performance information and provides transparency to IT operations management and the enterprise-wide business.
- Accountability: eCams HealthBeatTM tracks and prepares users with critical business metrics provided in an enterprise view based on federal standards through a graphic dashboard. MITA business maturity improvements become possible through key MITA business-area monitoring measurement
- Readiness: The Alert Engine provides the user to subscribe to monitoring functions for a specific or conditional change in the Stats through e-mail, based on the user subscription. The product also supports service level agreement compliance tracking with automated alerts and trending features.
- Versatility: eCams HealthBeatTM is available in Web application format and also in Mobile application format supporting iOS iPAD and Android tablets.
Learn more about HealthBeat™ here.
Comprehensive Tracking for Managed Care Compliance
CNSI’s MC-Track® is an intuitive managed care compliance tracking system that provides an in-depth understanding of contract terms and compliance requirements, providing customized stakeholder views to help project compliance scores of health plans across different paradigms – from measuring the quality of service to the timeliness of reporting requirements.
MC-Track® is a web-based solution that enables both states and the health plans to upload and maintain the contract document, create a comprehensive view of contract compliance metrics, track compliance measures and meet all contract obligations.
In a health care system where cost and quality considerations are of paramount importance, MC-Track® ensures better health outcomes through strict adherence to compliance and quality measures, allowing health plans to proactively pursue contractual financial incentives and capture at-risk revenue by ensuring compliance and avoiding contractual penalties.
Learn more about CNSI’s MC-Track® platform here.
Rules Management System
CNSI’s Business Rules Management System (BRMS) allows users to define Business Rules quickly and easily – requiring no programming skills. RuleIT helps enterprises implement business decisions by managing and configuring the Business Rules that drive their business processes.
- High Performance: Unlike other rules engines, RuleIT uses a “sequential process” algorithm, in which the evaluation is controlled by the rule, its conditions and the associated branching.
- Flexible: Rules engine architecture provides the flexibility of allowing a Business Analyst to determine the sequence of rule evaluation for a single rule or a series of complex process flow rules.
- Cost Efficient: Given the overall average Software Development Life Cycle effort ratio of 40 percent development to 60 percent maintenance, RuleIT dramatically reduces an application’s maintenance and extensibility costs.
- Proven: Architected and tuned for performance, RuleIT can handle most of the complex processing environments. RuleIT is proven and tested, and is currently in production with high volume and high-throughput applications, including Provider Enrollment and Medicaid Claims processing systems.
Learn more about CNSI’s Rule IT™ here.
Fraud, Waste & Abuse Detection
ClaimsSure is a real-time, prepayment, improper billing detection system which will prevent Medicaid, Medicare and commercial health care providers from making excess payments and highlight potentially fraudulent cases.
- Real-Time Execution: An incoming claim is associated with a probability of improper billing and sent back to the adjudication system in real time.
- Improper Billing as a Service: Improper billing is identified at a claim level so that the reviewers can efficiently investigate and take appropriate action.
- Multiple Improper Billing Patterns: Claims go through seven scenarios of improper billing which assume multiple patterns of improper billing.
- Plug and Play Device: ClaimsSure can be plugged at the end of the adjudication cue and used directly.
- Proven Methodology: ClaimsSure has an established success story of identifying a substantial amount of improper billing and stopping it before any payment is made.
Learn more about CNSI’s ClaimsSure here.
Consumer Engagement in One Touch
CNSI’s Consumer Engagement product suite acts as a bridge between payers and health care beneficiaries, comprised of myHealthPortal, a member-centric online web portal, and myHealthButton, a native mobile application counterpart – both of which will allow health care beneficiaries to securely access their health information.
- Custom: Both myHealthPortal and myHealthButton platforms provide personalized information, including demographics, healthcare providers, benefits and eligibility and health insurance.
- Accessible: They also provide the beneficiaries with online and real-time ability to make authorized changes, to see claims filed for services rendered by providers and to view or request a replacement mihealth card.
- Patient Ownership: The member is enabled to view benefits such as eligibility, coverages and other insurance details and request changes. The member is also empowered to view authorized providers, find a doctor, qualify diagnoses from state systems and set and track goals based on health behaviors and measures.
Learn more about CNSI’s myHealthButton® here.
To remain at the forefront of health IT solutions delivery, CNSI actively partners with
best-of-breed technology vendors and dynamic small and minority-owned businesses.
Our partnerships and teaming opportunities allow us to continue offering our clients the most flexible, secure, and cost-effective solutions possible.