Edifecs Enrollment Management consolidates traditionally disparate systems and automates manual processes. The modern, centralized platform, orchestrates the fragmented enrollment data streams for all lines of business. Health plans gain new visibility, operational efficiencies and faster onboarding times while safeguarding revenue with financial reconciliation.
Consolidate, automate and expedite enrollment operations across lines of business.View Products
With increased confidence in regulatory compliance, system scalability, and reduced manual intervention, MAOs can establish a competitive advantage.
- Enable real-time status tracking and intelligent workflow processing
- Drive expedient processing and delivery of confirmation letters to applicants
- Automate upfront data validation and system-wide orchestration
With intelligent workflows, financial reconciliation, and actionable visibility, MCOs gain new confidence in regulatory compliance while reducing operational costs.
- Streamline compliance with constantly changing state-specific rules and regulations
- Identify missing members and dis-enrolled members through comparison of roster details
- Centralize data validation and mapping with intelligent workflows
Marketplace & Exchange
Limited transaction visibility into enrollment operations can damage market reputation and lead to large amounts of membership churn. Leveraging marketplace-specific business rules, discrepancy reconciliation, and real-time transaction detail, allows health plans to focus on capturing a growing market.
- Validate inbound and outbound transactions against Exchange published standards, including non-834s
- Reconcile expected and paid subsidies, generate financial dispute reports and process financial dispute responses
- Reduce manual intervention and processing spend through automation and intelligent workflows, resulting in lower cost and less data errors
Improving Group enrollment performance requires insight. With comprehensive account visibility, intelligent workflows and collaborative tools for brokers and customers, health plans remove operational constraints, thereby reducing costs and accelerating quote to card.
- Onboard groups in a matter of hours
- Enable self-service capabilities for member coverage maintenance, corrections and audit discrepancy reviews
- Monitor expected transmissions or upload enrollment files outside of schedule