Medicaid Services

CHESS now offers independent primary care physicians solutions to meet NC Medicaid obligations, unlocking enhanced revenue and value based care payments.

The foundation of our support is our population health platform that we couple with right-sized care management services based on existing capabilities and requirements. Our services fall into three core service offerings based upon the provider’s capability and desire to provide Tier 3 compliant CM services.

Why Delegate?

We understand that every provider has unique capabilities and challenges when it comes to meeting AMH Tier 3 requirements. Rather than providing a “one size fits all” approach, CHESS works collaboratively with your team to understand requirements, identify gaps in readiness, and provide a detailed comprehensive plan to be successful as an AMH Tier 3 Network of practices.

Our Population Health platform enables providers to handle the data ingestion, integration, reporting, and care management operations. The CHESS Platform logic and Model of Care are based upon protocols, which drive care management workflows and analytics. These Protocols include complex care management, chronic care management, prevention & wellness, transitional care management, and care coordination.

Comprehensive & Flexible Service Offerings

Licensing – Population Health Data & Analytics

For providers with the capacity to provide care management services with their own staff but require a compliant Tier 3 platform for the management of an attributed Medicaid population.

Partial Delegation Care Management

For providers without the capacity to provide Care Coordination and Care Gap Closure to all attributed Medicaid members. Providers can customize this service to best fit their needs and capabilities, including options for licensing the CHESS population health platform.

Full Delegation Care Management

Offers a path to AMH Tier 3 benefits without making a sizable investment in staffing and supervision to ensure compliance with requirements. The CHESS care management team will ensure all key metrics are achieved to maximize performance.  

CIN Model

In the Clinically Integrated Network Model, CHESS holds the payer contracts and gives you the option to join. You also have platform access, Care Management Delegation, Contract Support and Integration, Provider Roster Management, and Provider Portal Verification and Auditing.