HealthFinance

HealthFinance delivers capitation rate summaries, fiscal analyses, and underlying assumptions for visibility into rate development, financial impacts, and cost drivers. It supports the full health actuarial and rate management life cycle; capitation rate development by program, population, and rate cell; and data quality controls over inputs. Automated CMS certification package generation (42 CFR §438.7/ASOP No. 49) and reasonableness checks reduce rework and improve rate filing defensibility. 

HealthFinance automates near real-time fiscal insights to enable data-driven policy decisions. The platform provides journal entry support with automated federal and state fund splits and Federal Medical Assistance Percentage (FMAP) tracking. It streamlines period-end reporting and close activities using payment and compliance data, while automating reconciliation workflows across payments, source data, and downstream reporting. These audit-ready outputs reduce manual re-keying between systems.

HealthFinance improves financial planning and analysis through advanced enrollment forecasting using time-series and machine-learning models, rapid scenario and sensitivity modeling, and integrated fiscal analysis tools. It can automate complex statistical analyses across populations and programs, reducing manual formatting and reconciliation during each budget cycle. Consistent, repeatable budget-cycle outputs improve the accuracy and defensibility of projections presented to leadership and CMS.

HealthFinance strengthens compliance and internal controls through medical loss ratio (MLR) monitoring, encounter data validation, CMS reporting package preparation, and compliance tracking across managed care organization (MCO contracts). Invoicing workflows connect approved capitation rates to the payment cycle—supporting accurate, timely disbursements and reducing the risk of errors in high-volume payment environments.