Increase quality. Shorten time to market. Reduce medical and operating costs. Ensure compliance.
Edifecs Enrollment Management is a highly comprehensive and configurable solution that allows for fast and automated enrollment, regardless of volume and channel (offline or mobile, through agents or automated exchanges—individual or employer).
It minimizes time to market for new enrollment strategies and channels, improves auto-adjudication rates for new members (or updates) and is capable of handling both complete and incomplete enrollment transactions (including the associated workflow). On top of this Enrollment Management provides full visibility, to manage all of the enrollment process in the most efficient way.
Edifecs Enrollment Validation performs automated validation of new enrollment transactions and enrollment updates even before they enter the health insurer’s back-office systems. In case of exceptions it supports the workflow for resolving issues in enrollment transactions. It allows for significant reduction of the onboarding time of new members and the work related to updating existing member information.
Edifecs Enrollment Automation allows for automated and structured intake of all kinds of file formats and transaction types that come through various enrollment channels. It manages and reconciles these transactions into a standard format and workflow throughout the process, including updates from the various external systems.
Edifecs Enrollment offers the tools to manage enrollment across multiple channels and up to extremely high levels of transactions. It automates the enrollment process, validates incoming transactions and provides payers with full visibility from complete overview to individual transaction details. It delivers an off-the-shelf software architecture.
The following capabilities support enrollment (both new members and updates) through multiple channels in high volumes with substantial operational efficiency.
The following capabilities help to quickly address membership issues in the enrollment process and with this decrease handling time, lower cost and reduce risk for enrollment.
The following capabilities enable full overall visibility of the enrollment process, both end-to-end and at the individual transaction level.