Government Programs Administration

With the rising Medicaid population precipitated by the Accountable Care Act, increased dual eligibility, the introduction of the Health Insurance Marketplace (HIM), and margin reduction allowed by the government, health plans across the United States are faced with the complex task of containing costs and providing quality care.

Argus Health has broad experience in providing comprehensive enrollment, administrative, and care management services to payer organizations that serve commercial and governmental markets, including Medicare and Medicaid. We can enroll and administer benefits and manage dual-eligible beneficiaries in compliance with Centers for Medicare & Medicaid Services (CMS) and state requirements, helping health plans improve efficiency, reduce costs, and remain focused on their highest priority: serving the member.

Medicare

The Argus CMS Program Office (CPO) consists of a dedicated team accountable for all Argus’ Medicare Part D activities. The CPO monitors, digests, and proposes solutions that meet federal guidance and rules to support our Medicare program customers. The Argus Health prescription drug events (PDE) acceptance is best in class; our plan-finder pricing files have a five-star rating and our explanation of benefit (EOB) and transition letter services make it easier for our customers to be fully compliant with CMS requirements.

In 2015, Argus introduced new Medicare services including: formulary management; rebate administration; clinical programs such as medication therapy management (MTM) and coverage determination; as well as a Star 5 program which integrates medical and pharmacy data to achieve the best member outcomes.

Medicaid

To support the Medicaid growth precipitated by the Accountable Care Act, Argus Health created a Medicaid Center of Excellence (MCOE). The MCOE provides the foundation of our Medicaid program services by acquiring facts, education, and experience in the practical understanding of Medicaid outpatient prescription drug benefits and program requirements. Argus Health uses Medicaid program knowledge to establish excellence in our Medicaid business and system processes that forms the basis for customer long-term Medicaid drug benefits program success.

Argus’ Medicaid services include formulary management, rebate administration, clinical programs such as MTM and coverage determination, print mail, and encounter file services.

Duals

Argus Health’s business processes and service excellence with Medicare and Medicaid programs work together to support your dual eligible plans with Medicare services such as PDE, plan-find, and print mail products, and Medicaid services including encounter file services and state pharmaceutical assistance program (SPAP) wrap benefits.

Additional Medicare and Medicaid program services include formulary management, rebate administration, clinical programs such as MTM and coverage determination, and print mail.

Health Insurance Marketplace (HIM)

Argus Health is committed and prepared to support your Health Insurance Marketplace (Exchange), Quantified Health Benefits (QHP), and the prescription drug coverage component of essential health benefits.

Our regulatory team monitors and addresses the Center for Consumer Information and Insurance Oversight (CCIIO) for HIM regulations and reviews regulations, guidance, fact sheets, FAQs, letters, and news releases.

Argus Health’s HIM support includes excellence in processing HIM benefits, cost share reductions, grace period coverage, and edge server services. Additionally, we offer support services including formulary management, rebate administration, clinical programs, MTM, coverage determinations, and print mail services.