Enrollment Management

ACA  Enrollment

Optimize ACA Plan Enrollment Operations

Participating On The Public Exchanges With Legacy Technology Can Leave Plans Scrambling To Reconcile Enrollment And Financial Discrepancies. Subsequent Processing Delays And Errors Can Lead To Low Customer Retention Rates, Heightened Compliance Risks And Threatened Revenue Streams. Mitigating These Risks And Strengthening Market Share Is Achievable With A Modern, Enrollment Management Strategy.

Automate Coverage Updates

Automate the processing of multiple transactions received for the same member and void canceled initial enrollments, up front

Merge multiple updates/changes into a single transaction

Convert CIC Term/CIC Adds into change transactions

Enable Lifecycle Visibility

Deliver out-of-the box business-level view of processing and operational performance

Enable data element and transaction-level visibility

Ensure greater operational awareness through alerts and notification, across all lines of business

Improve Financial Reconciliation

Process payment remittances in any format

Reconcile to current and historical enrollment records and periods

Quickly identify missing payments or discrepancies in premiums or subsidy payments

Track expected, projected, and actual payments

Export and import financial details for offline review

Marketplace Regulatory Compliance

Out of the box integration and file processing for the FFM

Pre-configure state-specific guidelines, maps and validations rules

Enable support for baseline RCNI and RCNO, and pre-audit file formats

Transition smoothly from the FFM to any SBE

Streamline Discrepancy Resolution

Automate reconciliation against monthly enrollment audit files

Employ intelligent workflows to identify, assign and resolve complex discrepancies

Reconcile paid subsidies against expected amounts and generate dispute reports

Commercial Group

Improve Group Enrollment Satisfaction And Performance

Operational Constraints, Like Working In Multiple Enrollment Platforms That Lack Automation, Compound Problems, Challenge Scalability, And Damage Relationships With Plan Sponsors. Comprehensive Account Visibility, Intelligent Workflows, And Collaboration Tools For Brokers And Customers Can Shed Operational Burden And Increase Customer Retention Through Accelerated "Quote To Card" Experiences.

Deliver Collaborative Toolsets

Provide near-real time views into member status, enrollment details and historical member transaction activity

Enable secure access to resolve fallouts from front-end processing

Streamline “out of schedule” enrollment file uploads

Establish client-specific permissions by role and responsibility

Enable Lifecycle Visibility

Enable out of the box business-level view of processing performance

Ensure transaction-level view by status, and monitor scheduled or expected transmissions for assigned accounts

Implement a single view of enrollment transactions across lines of business

Enhance Partner Satisfaction

Decrease lead-time to production and accelerate onboarding

Enable configurable validations for separate TPA accounts

Manage multiple member transactions in the same file

Deploy a configurable and expandable rules library

Implement Intelligent Workflows

Automate discrepancy identification and route to subject matter experts

Enhance coverage level detail with error resolution workflows

Enable business-level views of transmission workflows, transaction failures and audit discrepancies

Decrease processing time and errors associated with manual intervention

Streamline File Intake

Mitigate the challenges of custom, non-standardized 834s, ANSII 834-5010, etc formats

Deploy enrollment reconciliation and discrepancy resolution workflows

Automate data error correction with configurable logic, and source of truth comparison

Enrich incoming transactions with additional data required for downstream systems

Enable changes-only identification and processing for reduced load.

Medicaid Enrollment

How Easily Does Your Enrollment System Handle State-Specific Nuances?

From Eligibility Rules And Reporting Requirements To File Types And Specifications, Every State Operates Managed Medicaid Enrollment Differently. Internally-Developed Enrollment Systems Can Address Some Of These Nuances, But They Also Introduce New Challenges And Increase Maintenance Costs. By Looking Outside Of The Organization For New Sources Of Automation, Visibility And Expertise, MCOs Have The Opportunity To Achieve New Levels Of Operational Excellence.

Accelerate Upfront Discrepancy Identification

Streamline the Identification of missing and dis-enrolled members

Improve changes-only identification and processing for reduced load

Improve processing speed and accuracy

Drive program scalability

Reduce IT and administrative costs

Deploy Intelligent Workflows

Enable real-time visibility into transaction fallout

Automate the routing of errors requiring attention

Resolve errors and reprocess transactions in real-time

Improve scalability through inherent solution flexibility

Decrease error rates and improve member satisfaction

Enable Lifecycle Visibility

Deliver out-of-the box business-level view of processing performance

Enable transaction-level view by status with analytics

Deliver a single view of enrollment transactions across lines of business

Implement Inbound Data Centralization

Validate all files in a single location

Reduce errors and operational costs and improve scalability

Manage multiple member transactions in the same file

Reduce manual fallout processing

Enrich incoming transactions with additional data required for downstream systems

Improve Financial Reconciliation

Improve the tracking and reporting of over, under and missing payments

Identify discrepancies in capitation, premium or subsidy payments

Automate closure or reopening upon receipt of expected adjustments

Export and import financial details for offline review.

Medicare Advantage Enrollment

Create Competitive Advantages With Successful Enrollment Management Operations.

Rapid Growth In Medicare Advantage Presents Challenges, But Also Creates Opportunities For Competitive Differentiation. Administrative Efficiency, System Scalability, And Seamless Compliance Protocols Can Be Assets For Customer Satisfaction And Sustainable Plan Growth.

Accelerate Eligibility Processing

Automate BEQ request and response file generation

Reconcile ESRD, subsidies and CMS data

Validate data with built-in workflows

Implement configurable business rules to reduce errors and fallouts

Accommodate Downstream System Integration

Develop integrations between all membership systems

Transmit all or only necessary data downstream

Enrich incoming transactions with additional data required for downstream systems

Reduce fallout and load on internal systems

Enable Lifecycle Visibility

Employ an out-of-the box business-level view of processing performance

Deliver transaction-level analytics

Enable a single view of enrollment transactions

Improve Member Correspondence Generation

Generate and preview letters at member, group and application level

Streamline rejection letter generation

Enhance enrollment and disenrollment status reporting

Solidify CMS integrations

Leverage MARx database details with near real-time entitlement data

Ensure daily Transaction Reply Report (TRR) processing, validations and workflow

Provide tracking of each submitted and received transaction