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Mass Enrollment

It is possible to do high volume, multi-channel and accurate enrollment of new health insurance members supporting straight through processing.

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.

Product Spotlight

  • Edifecs Enrollment Validation

    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.

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  • Edifecs Enrollment Dashboards

    Edifecs Enrollment Dashboards provide full visibility on all member enrollment transactions, whether new or updates. Through track and trace facilities and a full audit trail of all transactions it gives complete insight in the enrollment process and allows for early interventions where required. And this is true across multiple channels including mobile apps, offline enrollment systems, health insurance exchanges, websites and employers.

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  • Edifecs Enrollment Automation

    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.

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Capabilities

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.

Mass enrollment through multiple channels

The following capabilities support enrollment (both new members and updates) through multiple channels in high volumes with substantial operational efficiency.

  • Extensive interfacing capabilities for interaction with multiple channels of membership data
  • Translating various formats in one streamlined and automated flow of enrollment transactions
  • Full file comparison capabilities to detect updates in membership data that can be translated in individual enrollment transactions
  • Staging of incomplete enrollment transactions including workflow support to wait for financial requirements and add required fields into complete and correct enrollment transactions

Correcting/resolving membership issues

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.

  • Automated detection of incidents in all enrollment transactions
  • Full visibility and individual alerts of incidents at the transaction level
  • Clear indication of type of errors found
  • Workflow support to resolve issues

Full overall visibility of the enrollment process

The following capabilities enable full overall visibility of the enrollment process, both end-to-end and at the individual transaction level.

  • Real-time enrollment life-cycle insight
  • Extensive set of pre-built reports and visual dashboards to support enrollment process management
  • Track and trace, identify incidents at the individual transaction level
  • Ability to configure additional custom reports for specific purposes

Contact us

Edifecs Netherlands BV Nevelgaarde 403436 ZZ Nieuwegein The Netherlands
Main:
425-435-2000
Sales:
425-435-2200
Support:
855-333-4462