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East Coast Medicaid Plan

Wendigo Advisors was called in by an East Coast Medicaid plan that had been put on Corrective Action by the state. Wendigo worked with the plan to improve its core system configuration and processes.

Issues Faced

Our client faced a myriad of issues including:

  • Slow Claim Payment

  • Six-Figure Monthly Interest/Penalties

  • Eight Weeks of Claims in Backlog

  • Encounter Submission Issues

  • Lack of System Knowledge

  • Strained Vendor Relationship

  • Backlog of Configuration Updates

  • Regular Payment Processing Failures


Wendigo review and research included:

  • Analysis of system configuration

  • Review of vendor contracts

  • Log/DB Analysis for Payment

  • Examination of System Code Sets

  • Review of Custom Code

  • Evaluation of System Skills

  • Review Configuration Processes

  • Review User Security Settings

Wendigo Team

The Wendigo Team included:

  • Exec Oversight/Interim CIO

  • Interim Claims Director

  • System Configuration SMEs

  • QNXT Technical Architect

  • Software Development Specialise

  • Claims Processors


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Auto Adjudication

Wendigo worked with the client to improve processes and configuration settings resulting in improving their auto adjudication rate from under 30% to nearly 80% in 6 months

Claim Backlog

Wendigo provided experience claims processors to work through eight weeks of backlog and eliminate 6-figure monthly interest and penalty payments.

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Claim Interest/Penalties

Our clients backlog of claims was costing ~$50,000 per week! By reducing the backlog and improving the auto adjudication rate these costs were eliminated.

Encounter Submissions

Wendigo analyzed processes and past encounter submissions. Improving processes allowed resubmission of previously rejected encounters resulting in nearly $10,000,000 in recoveries.

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