Modernize your enrollment management
Simplify and streamline enrollment management processes to capture a greater market share across all lines of business.
Consolidate. Automate. Expedite.
Traditionally, many plans manage member enrollment through manual processes across disparate systems for different lines of business, which hinders growth and increases costs. Edifecs’ SaaS-based Enrollment Management solution consolidates these systems through a modern, centralized hub to enable the orchestration of fragmented enrollment data streams for all lines of business.
Edifecs Enrollment Management offers a variety of features, including a configurable and expandable rules library, automated routing and error correction, financial reconciliation, and the ability to customize transaction data for downstream systems. Our solution helps health plans gain new visibility, maximize operational efficiencies, and improve onboarding times—all while safeguarding revenue.
Enrollment Management Products
ACA Marketplace
Managed Medicaid
Medicare Advantage
Group Enrollment
Learn how Edifecs’ streamlined enrollment hub can help your organization achieve operational excellence.
Frequently Asked Questions
01
What are the biggest enrollment challenges for health plans?
There are a variety of challenges that can impact payers’ enrollment management operations, including:
- Fragmented data in nonstandard formats
- Using multiple channels and systems for enrollment updates
- State-specific nuances
- Detecting changes to enrollment information files
- Poor error handling and slower enrollment times
- No interoperability between systems
- Overreliance on manual workflows that hinder scalability
02
How can AI improve enrollment management?
Manually managing enrollment data requires a significant investment of time and resources. In addition, manual workflows are more likely to lead to errors, which create processing delays, slow enrollment times, and negatively impact the member experience.
By leveraging AI to highlight errors for manual review and perform batch error correction, health plans can significantly reduce administrative workloads and deliver much-needed support to their administrative teams.
03
What should payers look for in an enrollment management solution?
The right technology solution can help health plans overcome their biggest challenges in enrollment management. When evaluating potential enrollment management solutions, health plans should consider five key factors:
- Functionality – Does the solution do what you need it to do?
- Compatibility – Is the solution compatible with internal and external systems?
- Security – Does the solution offer preventative controls and audit trails?
- Scalability – As your business grows, will the solution be able to grow with it?
- Maintenance – How much time/resources are needed to maintain the solution?
For a deeper dive into the keys to selecting an enrollment management solution, read our blog post on the topic.
News & Insights
Overcoming Marketplace Open Enrollment Challenges
Is your health plan too bogged down dealing with legacy enrollment platforms to pursue strategic initiatives? We unearthed common challenges plans face while participating in public exchanges
Enrollment Management for Medicare Advantage
Competition in Medicare Advantage is fierce for good reason, but that doesn’t mean new and existing participants can’t prosper. In fact, with the right systems in place, MAOs can lean on their competitive advantages and achieve heightened levels of profitability and member satisfaction.
One Enrollment Hub to Manage All Your Channels
With dynamically changing regulations and legislation around coverage, subsidies, and penalties, health plans must optimize their enrollment operations to be able to respond quickly to such changes, and gain a competitive edge over those who are underprepared.