Situation
The Centers for Medicare and Medicaid Services (CMS) engaged Dynanet for strategic, technical and program management advice, guidance and support services.
Process
Our technical knowledge and collaboration with the other integrators was critical to the success of the clear final outcome for this project.
Our mission was to ensure that claims are adjudicated accurately and timely. As one of four fee-for-services (FFS) integrators, we understand this process, as Dynanet maintains and enhances a version of the CMS Common Working File (CWF) system. We are the only small business that maintains one of the corresponding CMS systems.
Our support of the CWFM system was central to clarifying this process that ensured all FFS claims for HHS CMS are resolved in a timely and orderly fashion. The CWFM system performs benefit coordination and pre-payment claims validation for Medicare Part A (hospital and nursing care) and Part B (doctor visits, lab tests, and medical equipment).
Results
The CWFM system processes over 1.2 billion claims per year totaling more than $400 billion claim payments per year. This ensures that Medicare and Medicaid recipients get their payments on time.
