$60M
eligible for federal reimbursements
$20M
in direct savings for state
$10M
annual grant funding secured
Client Intro
The Maryland Department of Health (MDH) manages billions of dollars in Medicaid payments through its Public Behavioral Health System (PBHS), using Administrative Service Organizations (ASOs) to process claims and manage healthcare data across 30+ programs.
To ensure ASOs follow complex rules and bill accurately, MDH relies on expert partners like DMI and Softech to monitor performance, enforce policy, and secure funding.
Challenge
Monitoring payment accuracy is deeply complex amid evolving PBHS systems and policies, complicated funding rules, and multiple data sources.
With limited staff and multiple ASO changes, MDH was under pressure to review billions of dollars in claims, apply policy rules, and support providers, while simultaneously avoiding delays, unnecessarily denied claims, and fraud risks.
To keep services running smoothly and avoid costly mistakes, MDH needed a partner with expertise to spot red flags, fix errors, and protect state funding.
Solution
DMI and Softech serve as MDH’s trusted oversight partners. Together, they bring policy knowledge, data analytics, and provider insight to help MDH manage $2.7 billion in Medicaid payments across 5,000 providers.
The DMI and Softech team audits payment systems, validates business rules, and reviews claims data to spot red flags – like providers billing for more than 24 hours in a day. Last year, they referred 25 providers for further investigation.
DMI and Softech also compile a Treatment Episode Data Set (TEDs) to help MDH meet federal reporting requirements and secure millions in annual grant funding.
When ASOs change, DMI and Softech help MDH preserve institutional knowledge, guide smooth transitions, resolve provider issues, and maintain continuity and compliance without disrupting care.
Technologies and Capabilities
Expert Audits
Advanced Analytics
Policy Insight
Impact
Thanks to DMI and Softech’s oversight, MDH significantly cut financial waste and improved Medicaid efficiency.
In just two months, the team identified $60 million in payments eligible for federal reimbursement. Their work also helped prevent overpayments and fix billing errors, saving the state more than $20 million.
Using fraud detection tools, DMI and Softech help MDH catch improbable claims before payments go out. Meanwhile, faster support and fewer delays have improved trust across Maryland’s provider networks. And by helping the state meet federal reporting requirements, DMI and Softech ensure Maryland continues to receive nearly $10 million each year in grant funding.
Through consistent ASO oversight, DMI and Softech have built a model for Medicaid efficiency, compliance, and cost recovery.
About DMI
DMI is a leading global provider of digital services working at the intersection of public and private sectors. With broad capabilities across IT managed services, cybersecurity, cloud migration and application development, DMI provides onsite and remote support to clients within governments, healthcare, financial services, transportation, manufacturing, and other critical infrastructure sectors. DMI’s commitment to excellence in service delivery has resulted in dramatic growth, with clients among all fifteen U.S. Federal Departments and hundreds of Fortune 1000 companies.
