PW 2013 Presentation: Gaining Compliance and Optimizing Performance by Automating Appeals

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Together with WellPoint’s affiliated health plans, Amerigroup serves more than 4.5 million beneficiaries of state sponsored health plans in 20 states, making them the nation’s leading provider of health care solutions for public programs. To support its complex, distributed model, Amerigroup extended its Pegasystems footprint to provide a single platform for automating Medicaid appeals. Deployed in less than five months, the process-driven solution has enabled specialization and improved customer service while also providing standardization, compliance and numerous efficiencies.

  • How Amerigroup developed its common process and howthe solution supports specializaton
  • How the solution is architected including incorporation of external applications and legacy systems such as Facets
  • How appeals have been automated including what efficiencies and service enhancements are now provided


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