Benefits and Payer Services

Delivering operational effectiveness through real-time big data analytics

For federal agencies that manage benefits programs, CACI supports programs spanning the entire payer-beneficiary process and offers services ranging from custom application and database development to the sustainment of legacy systems and reduction of operational costs.

The agencies we support include The Centers for Medicare & Medicaid Services (CMS) and the Veterans Benefits Administration (VBA).

Our capabilities in benefits and payer services include:

Digitized Claims Processing Solution: CACI digitizes hundreds of millions of claims document pages (including 673 million for the VBA), enabling the automation of claims processing that is helping a major government agency meet critical goals for reducing backlog. Our information assurance solutions ensure the confidentiality, integrity, and availability of records.

Beneficiary Portal Development and Information Exchange: We create intuitive beneficiary web portals and front-end applications that access legacy systems in order to streamline business processes and enhance customer interaction.

And while data access from agencies interacting with beneficiary programs is complex and shifting, our IT solutions facilitate accurate data exchange between and within agencies.

Eligibility Determination and Case Management: CACI develops rule-based applications that automate the determination of beneficiary eligibility and help adjudicate conflicts, saving time, resources, and cost.

Spanning the full lifecycle of beneficiary cases, our solutions for processing vast amounts of multiple-source data improve customers’ ability to handle the complex cases typical of health-related benefits.

Benefit Program Analytics: We apply innovative big data analytics solutions to the measurement of any aspect of beneficiary program implementation, including eligibility, enrollment, claims, payments, disputes and appeals. This helps agencies optimize benefits program parameters and serve eligible populations more effectively.

Conducting analysis on large volumes of data requires specialized expertise in data warehousing and business intelligence methods, and our expertise in both traditional and emerging technologies enables us to tailor solutions that fit the requirements of our customers.

Fraud, Waste, and Abuse Detection and Prevention: CACI’s analytics solutions enhance program integrity by detecting fraud, waste, and abuse. Our predictive analytics enable early indication of incidents threatening program integrity to enable preventative measures.

From a benefits analysis perspective, this capability enables agencies to fine-tune programs ahead of the demand for new services.

From a program integrity perspective, it enables agencies to identify fraud ahead of the payment cycle, thereby increasing the effectiveness of program integrity activities and precluding the “pay-and-chase” paradigm.

Information Security and Assurance: CACI works with large-scale healthcare systems development teams to ensure that data is secure during transmission, processing and storage.  Additionally, our teams assess healthcare systems to assess their adherence to security standards and provide recommendations for security enhancements.

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