Unify and scale enrollment operations

Leverage a consolidated enrollment management system to strengthen relationships with members and stakeholders.

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Enrollment Management

Market expansion, acquisitions and organic growth have led health plans down a path of operating and maintaining multiple, siloed, enrollment systems fraught with manual processes. This has resulted in exacerbated enrollment costs, reduced visibility, member/stakeholder abrasion and, ironically, growth impediments. To ensure positive relationships with their members and stakeholders, reduce costs and ensure continued growth, health plans must embrace the utilization of a consolidated, scalable enrollment management system, spanning across programs and lines of business.

Our Approach

Edifecs Enrollment Management solutions are built specifically to address the evolving enrollment needs of health plans across products. Our platform support delivers standardized enrollment intake processing and integrated workflows, regardless of intake format or membership source. Dashboards and self-service capabilities ensure transparency and improve stakeholder satisfaction.


Standardize enrollment intake

Enable real-time integration with multiple enrollment sources through a standardized enrollment intake workflow for individual, group, and Medicaid enrollment.

  • Standardized support for 834 and FFM formats.
  • Configure and support any structured format across all enrollment channels.
  • Easily onboard new accounts and configure line of business specific validations.
  • Standardized transaction processing models and large library of common business edits and validations.

Minimize health plan business and financial risk of state exchange and Marketplace integration

Ensure compliance and adherence to changing requirements while safeguarding health plan revenue.

  • Hold and reconcile binder payments to ensure accurate effectuation.
  • Identify and reconcile discrepancies between exchange/Marketplace and health plan enrollment system to safeguard health plan IT systems.
  • Manage remittance advice for EFT notification, subscriber policies and small group coverage.
  • Reconcile and audit exchange/Marketplace enrollments, producing discrepancy detail reports for a current view of enrollment status.

Empower employer groups and other stakeholders through self-service and transparency

Improve stakeholder satisfaction and streamline cumbersome operations.

  • Deploy on-boarding workflows for enrollment facilitation.
  • Enable enrollment staff with an interface designed to track and support assigned employer group accounts.
  • Onboard new employer groups and partners quickly through self-service connection testing.
  • Provide secured web portal access for employer groups and partners to view and resolve enrollment transaction fallout.
  • Deliver full-file processing, monthly audit reports and discrepancy resolution capabilities.

Turn enrollment data into actionable intelligence

Gain valuable insight from an enrollment "source of truth" across programs and LOBs.

  • Expand health plan capacity to launch new products and consumer experience strategies.
  • Enrich product analytics with historical views of customer product selections to improve sales, marketing and product development targeting.
  • Support churn analytics with a consumer repository of clean enrollment history that crosses lines of business and products.
  • Support a separate, extended data model for enrollment.