Medicaid Funds Recovery

Enhanced Coordination of Benefits

Sohema allows workers to record and manage the identification of third party group health insurance policies for Medicaid funds recovery. Sohema includes the condition or status of the case and records information extracted from the MMIS system via a system interface, insurance limits associated with a MassHealth member, the application of a Medicaid member, diagnosis information, the discharge plan, patient service information, and cost avoidance. Sohema also manages case worker’s progress through the case, which is guided by a workflow checklist that must be completed prior to closure of the case.

Premium Assistance

For Premium Assistance, Sohema tracks payments made by the state Medicaid program to group health insurance policies. Sohema then calculates premium assistance and over and under payments, and records manual check payments.   Sohema also aids in the mangement of over payment recovery processes.