Infographic - Medicare Advantage


Accelerate Eligibility Processing

  • Automate BEQ request and response file generation
  • Reconcile ESRD, subsidies and CMS data
  • Validate data with built-in workflows
  • Implement configurable business rules to reduce errors and fallouts
  • Streamline the administration of Medicare Supplement (Medigap) coverage

Reduce poor data quality and high error rates to enable efficient enrollment file processing and data/subsidy reconciliation.

Accommodate Downstream System Integration

  • Develop integrations between all membership systems
  • Transmit all or only necessary data downstream
  • Enrich incoming transactions with additional data required for downstream systems
  • Reduce fallout and load on internal systems

Enable file-agnostic ingestion and processing capabilities to ensure timely effectuation.

Enable Lifecycle Visibility

  • Employ an out-of-the box business-level view of processing performance
  • Deliver transaction-level analytics
  • Enable a single view of enrollment transactions
  • Drive visibility into, and improve the administration of, employer group waiver plans (EGWP)

Enhance visibility into the enrollment lifecycle, to reduce inefficiencies like rejections.

Improve Member Correspondence Generation

  • Generate and preview letters at member, group and application level
  • Streamline rejection letter generation
  • Enhance enrollment and disenrollment status reporting

Improve the delivery of prompt and compliant letter fulfillment for MA success.

Solidify CMS integrations

  • Leverage MARx database details with near real-time entitlement data
  • Ensure daily Transaction Reply Report (TRR) processing, validations and workflow
  • Provide tracking of each submitted and received transaction

Ensure CMS sand MARx file compliance for improved regulatory adherence.