MCO: Fuse™ Agency Management for MCOs

Faster Time to Care, Right From the Start

Fuse Agency Management for Managed Care Organizations (MCOs) is an integrated homecare platform that seamlessly connects MCOs, homecare providers, and states. With it, MCOs can improve communications, reduce inefficiencies, facilitate workflows, and deliver comprehensive insights across the homecare continuum.

End-to-End. Empowering. Insightful.

More Efficiency, Transparency, and Compliance

Our MCO Agency Management platform addresses critical operational and delivery components by automating the distribution of cases to MCO providers, streamlining payer-provider communications, leveraging the point of care to ensure Electronic Visit Verification (EVV) compliance, simplifying the EVV to 100% electronic claims generation and remittance management process, enabling providers to generate, deliver, and receive validated, “clean” claims, delivering actionable, analytic member and provider insights, and providing seamless interoperability for all key homecare stakeholders.

A Comprehensive MCO Solution

It begins with end-to-end EVV, including data aggregation and claims validation. Besides capturing more member data for preventive care and minimizing the need for investigations, it ensures your compliance with the 21st Century Cures Act. Next, we automate manual and time-consuming care coordination processes and decrease the time required to connect providers and patients. Because we provide greater visibility into program data, you have what you need to increase accountability and improve performance and patient care.

Order Manager

Order Manager expedites the distribution of member cases to improve homecare service delivery for your members. Accessed via a web-based, HIPAA-compliant portal, the automated process enables real-time, secure communication with your provider network. Other benefits include:

  • Intelligent order routing and distribution to best-matching, most responsive providers
  • HIPAA-compliant, secure two-way messaging to eliminate follow-up and case inquiry calls and improve productivity
  • Seamless integration to eliminate redundant data entry and minimize errors
  • Preferred routing and case placement capabilities that better match members and providers
  • Secure attachments to eliminate document mailing and faxing
  • Robust audit log to track all member/authorization details and demonstrate compliance

Clean Claims

Clean Claims leverages an enhanced claims editing solution, as well as a partnership with the nation’s leading clearinghouse, to validate EVV data against homecare claims and applicable authorizations. Key benefits include:

  • Pre-adjudication authorization to EVV to claim validation (cost avoidance vs. cost recovery/pay and chase)
  • Payer savings for technical and operational overhead costs
  • Reduction in provider abrasion as they continue to utilize vendor of choice
  • Low technical lift for payers to implement in comparison to building a solution themselves. Complete elimination of respective technical maintenance.
  • New EVV Payer ID and connection to delineate workflows from existing non-EVV business

Fraud, Waste & Abuse Analytics

It’s crucial for homecare providers to be vigilant, implement robust compliance programs, and collaborate with regulatory bodies to ensure the integrity of homecare services and prevent Fraud, Waste & Abuse (FWA). The Sandata FWA Dashboard provides insights into:

  • GPS distance between the member and caregiver (filtered by distance with summary and details)
  • Employee/provider/member matches with exclusions and sanctions lists: Exact match (SSN/NPI/Registry ID, etc.), Confidence matching
  • Conflicting visits
  • Overlapping services
  • Authorization variances
  • Visit exceptions

Why MCOs Choose Sandata

“Before Sandata, we were validating EVV to claims post-adjudication and played the ‘pay and chase.’ Since we have partnered with Sandata, we’ve reduced our claim denial rates and reconciliation costs, as well as having much higher claim auto adjudication and first pass rates.”

Related Resources


Value-Based Care and Revenue Cycle Management

What is value-based care, and what does it mean for your agency? In short, value-based care focuses on creating positive patient outcomes rather than fee-for-service reimbursement. The goal is to be proactive, rather than reactive, and reward providers for helping patients become healthier—not just treat conditions after they occur.


Tips and Tricks for Revenue Cycle Management Success for Providers

Providing the best care possible to your clients is your main priority as a homecare or I/DD provider, but operating within the industry can provide distractions that inevitably shift your focus away from your clients.


The “Ins and Outs” of Insourcing vs. Outsourcing Revenue Cycle Management: Part 1 – Outsourcing Decision Impactors

The revenue cycle – the series of steps related to reimbursement for services that occur from intake to payment – is the lifeblood of any homecare or I/DD agency. You can provide the best client support with excellent outcomes and grow like a weed, but with the thin margins we experience today, your agency will struggle if you don’t collect almost 100% of the revenue to which you are entitled.

Learn How We Can Transform Homecare at Your MCO

Go beyond EVV to ensure higher quality, efficient, and compliant homecare services for your valued members. Get in touch to get the conversation started.

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