Contact Us 
(714) 805-6202
​contactus@tracscout.com
Challenged with keeping up with complex UM and G&A Requirements?
Let TRACSCOUT do the heavy lifting. 
We developed TRACSCOUT as the response to the industry’s pressing need for an affordable, fast and easy-to-implement solution for health plans and delegated entities that need to comply with CMS’s complex rules for Utilization Management and Grievances & Appeals.​
  
Despite best efforts, many organizations still struggle with compliantly managing UM and G&A.
​As industry veterans we knew there had to be a better way. ​​ Our suite of products and services includes:​
  • Software tools for comprehensively managing the Utilization Management and Grievances & Appeals processes, including monitoring, reporting and universe production for audits
  • Delegation of  UM and G&A processing functions
  • Consulting expertise to assist your organization achieve compliance 

  
We offer solutions for Tracking, Reporting And Compliance ... or TRAC for short.
Let TRACSCOUT do the heavy lifting when it comes to driving the complex processes of administering organization determinations, appeals and grievances.
Drive compliant workflows for staff at all levels of each process
Why TRACSCOUT? TRACSCOUT solutions  are easy to integrate and enable organizations to lower operational costs by avoiding timely and costly technology implementations. As industry veterans, we know what it's like to be concerned about exposure related to compliance issues in UM and G&A. The risks to Star Ratings, bonus payments and audit success are greater than ever. We know how important it is to demonstrate vigilant oversight over these highly scrutinized functions. Our processes have already been tested in the field, impressing  auditors from CMS, accrediting bodies and data validation organizations.  Our solutions and services are flexible; use our field-tested tools or let our experienced team handle some or all of these functions as a delegated entity.
Easily monitor, report  and produce universes for audit
  • Individually track all requests within a single record for each member
  • Maintain categorization in accordance with CMS and accrediting body requirements
  • Drive compliant staff workflows at all levels of the process, including work queues and emailed notifications
  • Calculate timeframes for different types of requests
  • Store and easily access all supporting documentation related to each case
  • Access to desktop procedures and job-aids
  • Automated date/time stamp entries with user attribution
  • Maintain library of compliant letters and notices
  • Drive production of batch processing of notifications
  • Robust calendar functionality to maintain tickler and task reminders 
  • Effortlessly produce universes for CMS and accreditation audits
  • Maintain detailed records and reports of monitoring and oversight
  • Easily import from and export data to other enterprise systems
  • Flexible forms and templates that conform to your current documents and forms
  • ​Implement in 4 weeks or less with little to no IT involvement
  • Low cost of entry
Demonstrate compliance with CMS rules 
Praise for our UM Tools
"The system was shown to be clear, concise and inclusive of all CMS universe requirements. "


"The Sponsor’s denial letters have been enhanced through use of their system, which imports data directly from specified fields, eliminating the need for free-form paragraphing, and eliminating any transcription errors from the system documented rationale to the letter. Additionally, the Sponsor has developed  beneficiary-friendly phrasing and descriptions for various CPT codes and procedures that can be selected via drop-down box within the system to standardize the language used."

Quoted in Final Report of
Validation  Auditor Post CMS Audit
"The Sponsor displayed detailed reports and procedures used for conducting daily quality review of all medical necessity determinations made."


Praise for our G&A Tools 
"The Sponsor also demonstrated its new tracking system for grievances, and was able to show the quality and monitoring reports, as well as universe files, that can be easily pulled from the system to accommodate daily monitoring and audit requests."

"By using this system for its grievance, appeal and organization determination processing the Sponsor has been able to map all universe required fields, ensure its ability to produce quality universe files in a timely fashion, and also use colorcoding within the system to clearly outline the fields required for each case type, depending on whether it has been categorized as a grievance, appeal, or pre-service organization determination. "

"The system also allows easy access to relevant procedures and job aids, reducing the potential for errors in categorization and case handling."
​
Quoted in Final Report of Validation  Auditor Post CMS Audit
​

You can implement our solutions in four weeks or less with little to no IT involvement.

Our fully encrypted solutions reside in the cloud so there are no software or hardware requirements. You and your team can be up and running fast.

  • User level security
  • Accessible remotely (including mobile devices) – fully encrypted web hosted solution
  • HIPAA compliant
  • Manages communications and reminders
  • Logs users actions and activities (time/date stamp)
  • Allows for input through links and web forms and automatically populates
  • User controlled dashboard reports
  • Customizable views
  1. Small Health Plans
    TRACSCOUT's low cost of entry and hassle-free implementation makes our solutions a low-risk proposition. If you need assistance setting up your processes, we're here to help with industry experts that will walk you through every step of the way. And if you need to augment your staff for optimal performance, let our experienced team take over some or all of these functions. We know how to seamlessly become an extension of your current team.
  2. Large Health Plans
    If your legacy systems are letting you down, let us show you how TRACSCOUT's solutions can work with what you already have in place to ensure you can capture all the data points you need and produce reports to meet CMS requirements. Our flexible systems and services can accommodate your organization... whether you have 10,000 members or 10 million.
  3. Delegated Entities
    FDRs are under increasing scrutiny as health plans race to demonstrate appropriate oversight of delegated functions. Let us show you how TRACSCOUT's flexible tools and services help you provide added value to your health plan customers through robust reporting, universe production capabilities and access to easy to use oversight tools.
About Us
We're a team of industry veterans from health plans and organizations that have experienced countless audits. We've helped organizations large and small optimize or remediate their UM and G&A processes.
Our health plan, technology and government program expertise makes us valuable partners. Let us show you how you too can achieve the peace of mind that comes from knowing your UM and G&A departments are running effectively and compliantly.

We don't have sales people... just experts. Email us anytime if we can be of help.  Or better yet, grab a cup of coffee and give us a call. Our contact information is below.
CONTACT INFO
Telephone:
(714) 805-6202
Email:
contactus@tracscout.com