WESTBOROUGH, MASSACHUSETTS (PRWEB) July 26, 2016
Advalent, a pioneer of healthcare technology solutions has released a Simplified Enrollment (SE) solution, which simplifies Medicare and Medicaid enrollment processing in compliance with CMS and state guidelines. Advalent Simplified Enrollment (SE) is available as a true SaaS offering and is embedded within Advalent PaaS solutions with built-in automation.
Advalent Simplified Enrollment (SE) features include the ability to match paper applications with the Advalent Enrollment suite which also encompasses of EDI Gateway, Medicare new Enrollments & Plan Benefit Package (PBP) changes, Election period with 100% accurate electronic batch file generations, calculating late Enrollment Period, electronic processing of the Transaction Reply Report, correspondence of exhibit generations to print vendors, Broker files processing and Advalent Customizable Interface (ACI). Advalent Simplified Enrollment (SE) suite features a complete set of monitoring dashboards which are enriched customizable portals offering a highly automated model, promoting operational efficiency, allowing plans to achieve simplicity with minimum wasted effort and without compromising program integrity. This suite manages automated processing of inbound and outbound enrollment transactions (Medicare / Medicaid / Exchange/ Commercial/ Custom) and is coupled with CMS Gateway and State Gateway.
- Complete solution for Medicare & Medicaid Health care management
- First in class design with ground up model bring readiness in consuming even complex health
- Plan structures from healthcare providers
- Modernized Medicare design bring readiness to consume period CMS changes at zero hassle
- High performance solution on the best in class infrastructure with performance, scalable with monitoring and management.
Advalent Simplified Enrollment (SE) is custom designed to accommodate CMS changes on the fly and start consuming them. If data and automation within this layer are well- managed, the benefits of the results are seen rippling through downstream systems such as SME, Claims, PBMs and DWH, etc.
- Application Intake via REST API, Interfaces, PaaS within secured channels
- Stay on top of CMS Compliance
- Application screening, validations against CMS guidelines
- Daily MARx Bach file Generation with automation and manual flexibility
- Ability to process daily Transaction Reply Report
- Built-in ability to generate correspondence with CMS Exhibits and to add more for each scenario
- Out of the box features with pre-validations for eligibility and guidance on RFI process.
Enrollment through Advalent Portal (PaaS), Consumer Web portal, Tele Application and more channels with:-
- Eligibility Check
- Election period(s) identification
- Effective date calculation
- Late Enrollment penalty calculation
- Premium withholds
- Rx Information
- Low income subsidy verification
- Multiple Riders
- Batch file generation
- Monthly files, transmittals, payment files consolidation
- Risk calculation
- CMS Submissions
Advalent Simplified Enrollment (SE) smart exception logic module and interactive dashboards make it possible for the health plans to automate enrollment, as well as monitor the exceptions received from members and plans. Based on the exception trends, configurable error queues are created allowing users to precisely and efficiently correct membership records. Advalent Simplified Enrollment (SE) suite users have seen payment and enrollment reconciliation errors reduced by an estimated 50 percent due to greater automation and accuracy, boosting the handling of discrepancies
- Easy to consume the SaaS services
- Exposed with REST API for easy orchestration
- State of art architecture with flexibility to customize on the fly with less effort
- Designed to embed with any business model with minimum to no impact on pre business flows