Managed Medicaid

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Every state’s managed Medicaid enrollment works a little differently, and your enrollment system needs to be able to handle these state-specific nuances. Many organizations develop their own systems and workflows to account for these variances, but doing so comes with a host of potential challenges—not to mention increased maintenance costs.

The Edifecs Enrollment Hub simplifies and streamlines these processes, providing the visibility, automation, and expertise organizations need to achieve operational excellence.

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centralize

  • Manage multiple member transactions in the same file
  • Reduce errors and operational costs while increasing scalability
  • Configure to match any state’s specifications

One hub for all your inbound data

Reduce complexity and increase visibility with a centralized hub for all state Medicaid intake data.

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anticipate

  • Streamline identification of missing and disenrolled members
  • Optimize quality of data transmitted to downstream systems
  • Reduce IT and administrative costs

Ensure high-quality data streams

Avoid the knock-on effects of bad data with up-front discrepancy identification.

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synchronize

  • Identify discrepancies in capitation, premium percentages, and discounts
  • Accurately track and report over- and underpayments
  • Automatically close transactions and reopen when adjustments are paid

Improve financial reconciliation

Minimize financial risk with automated reconciliation of member transactions.

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resolve

  • Correct errors and reprocess transactions in real time
  • Automate error routing for manual review
  • Gain real-time visibility into transaction fallout

Simplify error tracking & resolution

Intelligent workflows automate identification, routing, and resolution of enrollment errors.

Find out how we can support your health plan's performance.