Healthcare operations should not be a constant challenge for providers, administrators, and patients. We’ve all experienced what it’s like when systems and processes are not working as hoped and the experience becomes unbalanced. This puts strain on every entity, at a moment when a frictionless experience is what is needed most. This is our passion and our pride—to deliver a frictionless, empowering healthcare operation that benefits all.
Healthcare Operations
We help health plans, administrators, hospitals, and providers improve patient experience and program performance through system and process optimization.
“We started Garnet River Healthcare because of the growing need for organizations to meet regulatory standards through effective monitoring and oversight. Our approach is 360, and success for us is ensuring you have the right people, processes, and technology to maintain standards and and operate with sustainable excellence.”
Courtney Seypura, Practice Lead
Transforming mental healthcare with Consa
By harnessing the power of AI, Consa transforms mental healthcare by using AI-driven efficiency and precision to boost patient-centered treatment.
Health Carrier Uses Reg Matrix to Increase CMS Star Rating
After a CMS audit identified CAPs for a health carrier with 4 million members, we developed a Regulatory Matrix and helped mitigate and get CMS approval for all CAPs. Approximately 75 findings were identified with proposed solutions. The plan's CMS Star Rating increased by 1 point in most categories and an overall star rating of 4.5
Are you CMS program audit ready for 2024
Open enrollment activities are a true performance test of your company’s systems and processes. Garnet River Healthcare can get you 2024 CMS program audit ready.
CMS releases updated Plan Communications User Guide (PCUG)
CMS released the updated PCUG 17.4v for Medicare Advantage and Prescription Drug Plans. Changes are minimal, but the release is always a good time for you to revisit what you're doing.
Medicaid and CHIP eligibility
On August 30, CMS sent a letter to all 50 states, requiring a review of their eligibility systems. The impetus for this letter: CMS determined some states’ Medicaid and CHIP eligibility systems are incorrectly configured.
Part C & Part D Enrollment and Eligibility Guidance
On August 15, CMS released the updated guidance for Part C and Part D enrollment and eligibility. Included with the policy and technical changes was a new MA model enrollment request form.
Annual Election Period must-dos for Medicare Advantage Plans
To prepare for Annual Election Period, Medicare Advantage Plans and BPOs need to do more than cover cost and treatment. They need to elevate member experience.
Increase your CMS star ratings
From 2022 to 2023, ratings for MAPs have dropped, with less than half of plans receiving a good rating. Here's you you can increase your CMS star ratings.
Why Garnet River Healthcare
We help you work smarter, not harder. Garnet River Healthcare’s subject matter experts have over 35 years of industry experience. Our proven methodology focuses on people, process, and technology. And we leverage unmatched data analytics to optimize your operations and systems…yielding cost savings and successful audit outcomes.
We support: Health Plans, BPOs, CCBHCs, TPAs, State Public Sector & Federal Organizations, Hospitals, Healthcare Service Providers, ACOs.
Areas of Specialization
New Program Start-Up & Expansions ~ Business Process Improvement & Operational Excellence ~ Program & Vendor Oversight ~ Compliance, QA/IVV ~ Medicaid & Medicare ~ Compliance Repository
Service Offerings
“By leveraging data-driven decision-making and cutting-edge technologies, we help organizations navigate the complexities of the healthcare landscape, ensuring they are equipped to deliver exceptional care while maintaining financial sustainability.”
– Megan Christiana, Healthcare Products Practice Lead