One platform for Medicaid and Medicare compliance, configured to your program
MemberONE and ProviderONE aren’t built for a single program. Whether you run a Medicaid managed care plan, a Medicare Advantage plan, a D-SNP, or manage both, monitoring and directory verification configure to your specific state and CMS requirements — not a one-size-fits-all national template.
Who this covers
What varies by program
State-by-state variation
Compliance criteria are configured to your state’s Medicaid managed care rules and CMS Medicare Advantage requirements — not a generic national template.
Marketing & TPMO oversight
Call monitoring and scoring built around CMS Third-Party Marketing Organization requirements for Medicare Advantage and Part D marketing.
Scalable call-sample monitoring
Whether you need a small compliance sample or full call-volume coverage, monitoring scales to what your program and cycle actually require.
Provider directory standards
Continuous, multi-channel directory verification against NPPES, network adequacy rules, and your contract’s required cadence.
Dual-eligible complexity
Programs configured to reflect the added enrollment and communication requirements D-SNP members carry.
One platform, multiple programs
MemberONE and ProviderONE run on the same Salesforce-native foundation whether you operate a Medicaid plan, a Medicare Advantage plan, some variation of these or all of the above!
What HealthDetail covers here
MemberONE
Phone and call-center monitoring for Medicaid and Medicare marketing, enrollment, and TPMO compliance, with AI-assisted transcription and audit-ready scoring.
Learn about MemberONE →ProviderONE
Continuous multi-channel provider directory verification, NPI validation against NPPES, and audit-trail documentation for network adequacy compliance.
Learn about ProviderONE →
