3 Benefits for MCO's

Prefix directly influences the most important MCO metrics


Initial Eligibility

Our technology helps you so you can help providers determine initial eligibility.

Predict Churn

Our technology uses Machine Learning, Fintech, and AI to anticipate churn

Reduce Churn

Our technology helps you engage members for continuous eligibility.

The threat to continuous Medicaid eligibility has never been greater.

Red state Medicaid agencies are pursuing 1115 waivers for work requirements that specifically target working-age adults, and blue states are also evaluating eligibility more closely, resulting in more individuals being removed from the rolls. In many states eligibility processes are slow and inaccurate, both of which create bad debt and other headaches that negatively affect a provider's bottom line.

Prefix manages Medicaid eligibility status at scale.

Prefix is unique because it tracks every state of a Medicaid member through their eligibility journey - both when they are eligible and when they move outside eligibility bounds.  Prefix also predicts at scale.  We are constantly looking at where a member is heading both based on their individual attributes and in the way in which those attributes relate to everyone like them.

How it all works

Prefix delivers value where and when you need it, every step of the way

1. Initial Coverage

Prefix helps the client at initial application, working with providers to assist applicants in gathering the necessary information, condensing the information for quicker review, and submitting it to the state. MCOs can help themselves by helping their network providers acquire this technology.

2. Continuous Coverage

MCOs can direct members due for redetermination to the Prefix Health mobile engagement app to verify and submit needed eligibility information to the state to maintain continuous eligibility. Prefix is developing an MCO platform to assist members to report compliance with work requirements to states.

3. Predictive Analytics

MCOs can use Prefix algorithms to identify members who are most at risk of non- compliance with redetermination paperwork, work requirements, or any other compliance regime. The MCO can then identify those individuals for targeted interventions.

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