Medicaid and Long-term Care

Program/Provider Feasibility Evaluation Solutions

Reden & Anders Medicaid experts can assist your organization in evaluating the feasibility of a Medicaid program. We have a thorough understanding of Medicaid eligibility categories and services from evaluating acute services for a TANF program to long term care services for a dual eligible population. Many states are moving toward more complex payment structures including those based on evaluating the underlying health status of the population; we have the expertise and tools to help your organization achieve its financial goals.

Services & Tools:


ASC Calculator
The Reden & Anders ASC Calculator translates the various reimbursement allowances by the Medicare ambulatory surgical category (ASC) groupings into a single average reimbursement allowance per outpatient surgical encounter.
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Excess-of-Loss Rating Model
The Reden & Anders Excess-of-Loss Rating Models develop excess-of-loss premium rates for various populations with two tools; the Hospital Model calculates rates for hospital-only and global coverages and the Physician Model calculates rates for professional coverages.
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Fee Analyzer
The Reden & Anders Fee Analyzer is a tool which provides users with an efficient method to evaluate physician fee schedules. Evaluations can be performed against the widely used Medicare benchmark fee schedule as well as against any other fee schedule.
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Ingenix Health Technology Pipeline
This management tool is one of the few publicly available sources of information that contains both a comprehensive identification of developing health technologies as well as a projected cost impact and suggestions for operational adjustments to minimize costs. It combines the clinical information in the pipeline with financial forecasts so you can anticipate your future medical expenses and plan accordingly.
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Medicaid Consulting Services
Through our expertise, analytical tools, and pricing models, we help health plans, providers, and other public and private groups design and execute innovative, risk-managed strategies for improving access, quality and cost effectiveness in the state-run Medicaid programs.
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Medicaid Tools
Reden & Anders has the experience and tools necessary to assist your organization with your Medicaid at-risk product line. We have helped organizations in more than 30 states with Medicaid analyses. With this extensive experience and a large database of actual Medicaid experience, we have built a solid reputation with state agencies and their consultants.
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Medical Expense Model
The Reden & Anders Medical Expense Models provide users with the ultimate tool for developing forecasts of per member per month (PMPM) medical expenses under a multitude of assumptions. Payers and providers alike will appreciate the flexibility in assessing changes in specialty medical expense budgets due to changing utilization, reimbursement, benefits, and population demographics.
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Reserve Development Model
The Reden & Anders Reserve Development Model is a Microsoft® Visual Basic-based model that delivers quick calculation of estimated incurred claims and resulting unpaid claim reserves. Projections of incurred claims can be developed under a multitude of assumptions.
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Trend Forecast Model
The complexities in current health care costs require a new approach to managing trend forecasting. While all payer groups manage their trend forecasting process, the level of depth varies based on size and complexities of each organization.
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