Modernize Your Enrollment Operations

Grow top-line revenue and mitigate risk by establishing an Enrollment Hub.

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Enrollment Management

Staying competitive in today’s health insurance market requires more than just reducing costs. Successful health plans must emphasize top-line revenue growth, channel modernization, and member retention as well. Members today are more involved in their healthcare and as such they have higher expectations for the quality of service they receive from their insurer. Ensuring high quality requires a dedicated Enrollment Hub platform that accepts and integrates submissions from various stakeholders, in different formats and across a multitude of channels. Health plans must adopt a streamlined enrollment process that shortens the cycle from quote to card, creates a user-friendly environment for members, and mitigates churn.

Our Approach

Edifecs Enrollment Management provides an innovative enterprise solution designed specifically to mend fragmentation across health plan sales channels. Our platform’s unique Enrollment Hub approach provides seamless, integrated processing across various sales channels and lines of business, regardless of intake format or membership source. Dashboards and self-service capabilities create enterprise-wide visibility, allowing health plans to improve performance, enhance stakeholder satisfaction, and increase top-line revenue.

Capabilities

Elevate your enrollment operations through a fully automated and integrated enrollment process

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

  • Sales channel modernization
  • Standardize 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.
  • Standardize transaction processing models and deliver a large library of common business edits and validations.

 

Grow top-line revenue with remittance management, transaction tracking and payment reconciliation

Process payment remittances in any format and reconcile to current and historical enrollment records.

  • Manage remittance advice for EFT notification, subscriber policies and small group coverage
  • Identify discrepancies in capitation, premium or subsidy payments, including missing payments
  • Track recurring discrepancies for prioritized review and resolution
  • Easily generate reports for outstanding payments, discrepancies and send dispute reports directly to paying organizations

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.

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.
  • Reconcile and audit exchange/Marketplace enrollments, producing discrepancy detail reports for a current view of enrollment status.