Enrollment Automation

Reduce cost and increase operational performance by streamlining [member] benefit enrollment maintenance processes with employers, payers and carve-outs. Remain competitive in the marketplace by easily offering complimentary plans with specialty providers. Efficient and accurate enrollment is critical to verifying eligibility information, checking benefit details, coordinating care with plan partners, submitting claims and billing premiums.

Primary Drivers

  • Increase automation and accuracy for enrollment maintenance
  • Effortlessly coordinate enrollment with employer groups and carve-out carriers
  • Quickly respond to changes to support business
  • Improve performance while reducing cost with managing enrollment
  • Eliminate support of in-house black-box scripts and development efforts
  • Standardization of X12 834 model enabling consistency and automation with enrollment processing over proprietary file layouts, email/mail/fax member rosters and web sponsored portals
  • Reconciliation and audit of the monthly audit and all daily changes

Enrollment Capabilities

  • Simplified and accurate enrollment maintenance for employer groups, delegates, Medicaid and Medicare Advantage
  • Cloud-based EDI as a Service enabling visual collaboration and streamlining administration
  • Eliminate need for in-house development and application support by Healthcare EDI professionals responsible for managing proprietary transactions with trading partners
  • More efficient and less expensive than developing internal solution or black-box type outsourced services with limited or no transaction visibility
  • Capability to import and convert proprietary file formats into standard EDI X12 HIPAA compliant transactions, addressing EDI/HIPAA regulatory requirements
  • Automated data processing that allows benefit administrators and healthcare claim processors to funnel transactions through a robust translation and Advanced Rules Engine
  • Advanced Rules Engine incorporating 14+ years of business transaction processing expertise offering exceptional file optimization, configurable rules, and exception logging and reporting
  • Branded, intuitive EDI transaction portal for editing, error reporting and management of transaction activity with trading partner(s)
  • Workflows designed to enable business analysts to manage, remediate and report on incomplete data and rejected transactions
  • Full reconciliation and audit of the monthly audit and daily changes
  • Reduce administrative costs by automating common tasks and translating complex business logic with easy-to-use tools supporting workflow
  • Expedient system implementation that supports trading partners and outsourced business processes