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Mayuresh Joshi

Posted on June 25, 2024 | 4 min read

What to Look for in an Enrollment Management Solution


Consumer Experience

Healthcare Data

Operational Excellence

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What to Look for in an Enrollment Management Solution Edifecs

Enrollment management is notoriously complex and, without effective tools and processes in place, difficult to manage. Technology solutions can help health plans overcome the biggest challenges—fragmented data, security requirements, manual workflows, and a limited ability to scale—but what does the “right technology” look like?

Read on to learn the five most important attributes to consider in an enrollment management solution.


The first—and most obvious—consideration is functionality: does the solution do what your organization needs it to do?

Because guidelines and practices differ depending on geographical location and line of business, any enrollment management solution you consider needs to include a configurable and expandable rules library. This functionality makes it possible to reuse customizations across multiple clients, and it’s significantly faster than configuring rules from scratch to accommodate each customer’s individual needs.

There is no surefire way to completely eliminate enrollment data errors, but an effective enrollment management solution can go a long way towards minimizing their impact. Automated routing and error correction not only help significantly reduce error rates, but also ensure that when errors inevitably do occur, correcting them is less burdensome for your team.

The third feature you should look for in an enrollment management solution is the ability to customize transaction data for downstream systems. Data sharing is a pivotal part of effective enrollment management, but it’s only valuable if your trading partners can make effective use of that enrollment data to deliver a more connected and seamless member experience.


Your enrollment management solution is only as good as its ability to work with other systems. Otherwise, integrating with other internal and external systems will depend heavily on time- and resource-heavy manual processes that make it harder to achieve true interoperability.

The right enrollment management solution needs to be compatible with FHIR® APIs to ensure fast, seamless data exchange. This level of compatibility can help your organization reduce onboarding times from days to hours, deliver near-real-time views of member data, and collaborate more effectively with your partners across all lines of business.

It’s also important to consider if the enrollment management solution fits into a broader solution portfolio. Managing multiple products from multiple vendors can create unnecessary complexity and make it more difficult to get things done; if the vendor you’re considering offers other solutions, consider whether there might be a potential future need that those offerings could fill. The more you can consolidate under one vendor, the more seamlessly the individual components of your tech stack will work together.


Data security is paramount for any healthcare technology solution, and your enrollment management solution is no exception. Robust preventative controls and audit trails are essential for protecting your enrollment data, but that’s only one part of the equation.

An effective enrollment management solution will also offer the ability to respond quickly and effectively to current security risks, as well as allow for proactive protection against potential future threats. Most importantly, your solution should provide automated updates to security protocols and processes to reduce the need for manual intervention—and ideally, those updates should occur seamlessly without requiring extended downtime.


As you expand your enrollment operations, it’s essential that your enrollment management solution is able to grow with your business. The key to achieving scalability is minimizing manual intervention, and SaaS-based solutions are ideally suited to that purpose.

With a SaaS enrollment management solution, your organization will be better-equipped to quickly pivot according to changing business needs like adding new lines of business, expanding geographically, and increasing (or decreasing) capacity. The degree of flexibility offered by cloud-based solutions also means you can more easily adapt to your customers’ unique needs. That means faster and smoother onboarding—and, ultimately, a better customer and member experience.


Last but not least, the level of maintenance required is a key consideration when selecting your enrollment management solution. As with scalability, maintenance is another area in which SaaS solutions offer exceptional value. With on-premise solutions, your IT team is responsible for handling every update or upgrade, each of which requires downtime and takes IT resources away from the other vital functions they perform.

As a result, it’s not uncommon for health plans to fall into a pattern of “update triage”: only installing system-critical updates and ignoring the quality-of-life improvements that can meaningfully impact the customer experience. On the rare occasion that upgrades do take place, they’re often done as quickly as possible. As a result, code is inevitably added on top of the system instead of being meaningfully integrated; with each upgrade, the amount of tacked-on code grows, the system becomes more unstable, and the organization falls deeper and deeper into technical debt trying to stay on top of everything.

Given how often rules, guidelines, and customer needs can evolve (and how quickly that evolution can happen), it’s important to invest in an enrollment management solution that doesn’t require significant IT intervention for every update or upgrade.

How Edifecs Can Help

Enrollment can’t be effectively managed with manual workflows across a variety of disconnected systems. The process is simply too difficult—and the stakes are too high. Our SaaS-based Enrollment Management solution consolidates all those disconnected systems into a single modern, centralized hub for all lines of business.

With Edifecs Enrollment Management, you can finally see the complete picture of all your enrollment data. We recently helped a large health plan enhance their enrollment capabilities, reduce data management overhead, streamline member onboarding, and achieve a projected five-year ROI of $19.5 million. Want to know how we did it? Check out this case study.

With the right technology solutions, you can finally achieve the efficiency, scalability, compliance, and revenue security you’ve been looking for. To learn how Edifecs can help you get there, get in touch with our team today.

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