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Managed Care Medicaid Programs & Payer Systems

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Ankota has a legacy of providing solutions for the providers of managed care home care services such as state Medicaid programs for aging and disabled waivers and Consumer Directed Services (CDS). More and more states are entrusting these operations to Managed Care Organizations (MCOs) and outsourcing them to insurance companies or Business Process Outsourcing (BPO) firms.


Ankota provides the software needed to manage MCOs. The Ankota solution includes the following Capabilities:

  • MCO Operations:
    • Receiving referrals from the state
    • Choosing the best provider based on geography, capacity and performance factors
    • Electronic sharing of referrals, authorizations and care plans with providers
    • Provider operations software, ensuring compliant operations and clean claims
    • Electronic provider auditing capabilities
  • Provider Operations:
    • Receive referrals electronically via portal or full operations software including demographics, authorization and plans of care
    • Scheduling of care staff
    • EVV management using telephony, mobile app, FOBs or kiosks
    • Claim scrubbing so that clean claims are submitted
    • Claim submission and remittance processing
    • Ability (optional) to manage care from other referral sources