OVERVIEW

Enhance growth and member retention through modernized enrollment

Legacy systems create challenges caused by the lack of a single enrollment channel across commercial, marketplace, Medicare and Medicaid lines of business, inefficiencies in workflows, and longer member acquisition and onboarding timelines. Payers need to transition from traditional enrollment management with limited automation to being connected with states, CMS, exchanges and group business to deliver a seamless, personalized experience for members

CAPABILITIES

Powerful Platform

We deliver a single platform for managing enrollment across all lines of business. With a turn-key sales arm to enhance broker and direct-to-consumer channels, we reduce the loss of premium and reimbursement revenue by reconciling financial transactions against individual member enrollment periods

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Reduce enrollment administrative overhead and improve data accuracy

  • Automated premium billing and payment reconciliation
  • Up-to-date, clean membership data drives efficiency 
  • Modern and easy-to-use dashboards including member status and transactional history
  • Accurately process CMS files and maintain plan data in sync with CMS data
  • Automated letters to facilitate CMS compliance adherence
  • Out-of-box reports to track CMS mandated processing timelines
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Automate and Optimize Revenue Reconciliation

  • Identify and resolve payment discrepancies 
  • Auto-process MMR, LEP & MPWR Files
  • Auto-Process Lockbox, SSB, RRB Payments
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Eliminate fragmented enrollment processing

  • Manage end-to-end enrollment lifecycle
  • Configurable workflows to handle member enrollment status
  • Improve consistency across channels with adaptable rules engine
  • Accurate enrollment processing (high first pass submission rate)
  • Provide agility to handle policy changes and nuances of Marketplace, Medicaid and Medicare line of business
  • Real Time BEQ and DTRR automation
  • Process through multiple channels and formats including 834, flat files, xml files and scanned/digitized paper enrollment forms

BENEFITS

Trusted solutions with
guaranteed outcomes

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Boost member experience

Streamlined processes that maintain compliance, decrease costs, and improve member retention

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Improve consistency

Expedite enrollment, validate and edit election data, and improve consistency across all channels with our adaptable rules engine

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Optimize revenue reconciliation

Manage premium and capitation reimbursement revenue with transaction reconciliation across enrollment periods

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Adapt to changing CMS requirements

Monitor and improve CMS measures across multi-state service areas and maximize enrollment and lower disenrollment with compliant solutions

Improve efficiency and increase member satisfaction with self-service and call center tools, automated processes and real-time validation for all lines of business

24/7

Self-service tools for members

100%

All lines of business

100%

Real-time data validation

80%

Application process time reduction

Let’s unburden your health plan today

Reach out to discover how our innovative solutions can help unburden your plan and streamline operations. Together, we’ll elevate your business to new heights

CONTACT US
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SOLUTION GROUPS

Featured Core Administration solutions

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Engagement Plus™

Purpose-built digital service center that delivers optimal customer experience by integrating payer Core Administration platform with best-in-class consumer engagement point solutions for a comprehensive service platform
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Integration Plus™

End-to-end software as a service solution that allows you to integrate, scale and adapt with reduced implementation and development costs
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Workflow Plus™

Innovative operations management solution designed specifically to optimize workflows, processes and monitoring
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Insitz Plus

Leading-edge business intelligence and reporting solution designed specifically for health plan operations and performance