Medicare Advantage

Create competitive advantages with successful Enrollment Management operations.

Rapid growth in Medicare Advantage presents challenges, but also creates opportunities for competitive differentiation. Administrative efficiency, system scalability, and seamless compliance protocols can be assets for customer satisfaction and sustainable plan growth.

Infographic - Medicare Advantage

Features

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.

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.

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.

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.