Telligen has more than 45 years’ experience providing clinical, analytical, and IT solutions to State Medicaid and Commercial customers nationwide. We excel in providing modular, configurable solutions to help a government or employer program improve the health of its covered individuals, especially those deemed most vulnerable or high-risk.

Where return on investment is critical, Telligen delivers. The following are highlights some of Telligen’s strongest experience relevant to health plans.

Utilization Management, Prior Authorization and Clinical Performance Measurement

  • In Maryland, Telligen completes an average of 10,000 reviews, per month, covering more than 18 services, and has achieved an ROI of $4 in savings for every $1 in expenses.
  • In Oklahoma, between 2014-2019, high-risk members of the Telligen-administered health management program spent 50% fewer days in the hospital and 29% fewer ER visits.
  • Telligen performs utilization management in 8 states.

Care Coordination

  • In Oklahoma, since 2008, the Telligen-administered health management program has saved taxpayers $364.3M, through health coaching and practice facilitation services
  • In Idaho, where Telligen provides QIO, UM, behavioral health, and care coordination services, we have achieved an ROI of $6 saved for every $1 spent

Home and Community-Based Services

  • Telligen has performed more than 45,000 assessments for Medicaid MCO and fee-for-service clients
  • Telligen is the first in the nation to implement adult and child versions of SIS assessments
  • Telligen is the first in the nation to develop and implement PASRR Level I & Level II evaluations

Qualitrac™ – Our Technology Backbone

Qualitrac is Telligen’s proprietary, population health management application that does all the heavy lifting behind the scenes. It’s a configurable suite of inter-connected modules, developed in collaboration with clinical and technical experts, to address the complex challenges of any health program.