OUR MEDICAID SERVICES
Comprehensive Capabilities Across the Medicaid Ecosystem
Program Integrity, Audit & Compliance
​We help organizations strengthen program integrity, manage regulatory and compliance requirements, and improve oversight. Our professionals support audits, claims and payment review, provider oversight, fraud, waste and abuse initiatives, corrective actions, and other program-integrity activities.
Data, Analytics & Informatics
​We help turn complex Medicaid and healthcare data into useful information. Our capabilities include data analysis, healthcare informatics, data quality and validation, claims and encounter analysis, reporting, dashboards, and program-performance analytics.
Technology & Modernization
​Garnet River provides the technical expertise needed to modernize Medicaid programs and the systems supporting them. Services include business and systems analysis, requirements development, systems integration, testing and quality assurance, EDI, interoperability, and legacy-system modernization.
Program & Operational Consulting
​We help clients evaluate programs, improve processes, and execute complex initiatives. Our capabilities include program assessment, business-process redesign, project and program management, PMO support, implementation assistance, change management, and operational improvement.
Specialized Medicaid Workforce Solutions
​Garnet River provides experienced Medicaid professionals when and where clients need them—from individual subject-matter experts to multidisciplinary teams. Our talent capabilities include Medicaid SMEs, program-integrity and compliance professionals, healthcare data analysts, business and systems analysts, project managers, and technical specialists.
Public Health & Healthcare Interoperability
​We support the exchange and effective use of healthcare and public-health information, including HL7, healthcare interfaces, immunization information systems, data integration, informatics, and public-health reporting.
AI & INTELLIGENT AUTOMATION
Practical AI Built for Real-World Medicaid Operations
Garnet River helps organizations identify practical, responsible applications of AI and automation within Medicaid operations. Solutions can include intelligent document processing, workflow automation, data extraction and classification, knowledge management, and AI-assisted review—with appropriate human oversight.
ADAPTABLE TO YOUR NEEDS
Flexible Engagement Models
Every Medicaid challenge is different. Garnet River can provide a single specialized professional, an integrated project team, consulting expertise, technology solutions, or a combination of all four.
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That flexibility allows us to meet an immediate need while also helping clients build longer-term capabilities.
WHY GARNET RIVER
Bridging Expertise, Technology, and Execution
For more than 25 years, Garnet River has helped public- and private-sector organizations solve complex workforce and technology challenges. Our Medicaid Practice combines that experience with specialized healthcare expertise and a practical understanding of the environments in which Medicaid programs operate.
We don't approach Medicaid challenges from just one perspective.
We bring together people, process, data, and technology to deliver solutions that work.
