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Electronic claims settlement tool improves administration of capitated Medicaid HMOs

When the state of Georgia began transitioning Medicaid and PeachCare patients to managed care plans in 2006, providers encountered major delays in claims processing and settlement. But since two of the three health plans that serve as care management organizations (CMO) for Georgia Healthy Families adopted a software system called PaySpan Health, the tide has turned dramatically with respect to claims administration and cash flow to providers.

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