ON A
ROLL CALL
SIMPLIFY ELIGIBILITY,
ENROLLMENT, AND EDUCATION.
Enrollment Application and Demographic Management
Make getting members enrolled and informed easy. Our enrollment specialists successfully manage enrollments/disenrollments/status changes/demographic information ahead of CMS specified timelines, offer electronic enrollment or paper processes, and handles the most common file types including First Information Report (FIR), Best Available Evidence (BAE), Medicare Secondary Payer Coordination of Benefits (MSPCOB). We will review for completeness and validity including initial verification of Medicare eligibility, Medicaid eligibility, medical condition eligibility, and outreach to agents for missing information and discrepancy resolution. We will also keep your members informed. We can also print, mail and track Enrollment and Eligibility letters, Welcome Packets including ID card, Annual packets including Annual Notice of Change, LIS Rider, Summary of Benefits, etc. All communications are CMS compliant and can be provided in braille, large print, or audio options. Customized design including new marketing materials, provider education materials is also available.
CMS Data Exchange
Let us manage the technical standards and protocols to ensure data security and privacy. We can facilitate the process and infrastructure to share and receive healthcare data with various stakeholders including healthcare providers, insurance companies, researchers, and other government agencies. This will improve various areas such as patient care coordination, claims processing and quality measurement.
Electronic Retroactive Processing Transmission (eRPT)
Reduce your administrative burden by leveraging our Electronic Retroactive Processing Transmission (eRPT) system. This system-to-system transmissoin enables CMS to electronically communicate changes or adjustments to provider’s claim data – a crucial aspect in the claims management process allowing for the correction of errors or inaccuracies. You will be able to identify and correct claim errors quickly to increase efficiency and accuracy of claims processing.