Leverage Our Expertise

Dynamic Healthcare Systems provides Member Management and Risk Adjustment Solutions to Managed Care Organizations participating in Medicare, Medicaid, and Exchange programs. Partnering with Dynamic will help your Managed Care Organization Optimize Revenue, Streamline your Operational Processes, and Increase Efficiency while remaining Focused on CMS Regulatory and Compliance Requirements. 

Dynamic was founded in 2005 in response to the significant business and system challenges placed on Medicare Advantage Organizations (MAOs) by the enacted Medicare Modernization Act of 2003.  Dynamic recognized these challenges and established Dynamic as a Medicare Advantage solutions company, building solutions that keep health plans in compliance, help ensure accurate payments, and keep their system administration costs in check.

Enrollment  Eligibility

Consolidate multiple systems and processes into a single solution with best practices to meet all CMS regulations. Dynamic’s automated enrollment solution  utilizes extensive pre-submission validations resulting in reduced manual labor, simplified enrollment status checking, highly accurate enrollment processing, and the identification of secondary payers. Generate all the correspondence needed during the election, enrollment, and premium billing processes to meet all CMS requirements.

Revenue Reconciliation

Helps plans optimize revenue by highlighting and prioritizing discrepancies between plan data and CMS data including special statuses, demographic information, and risk scores. Easily load membership, bid information, and MMR to quickly identify member, special statuses, and payment discrepancies to streamline the attestation process. Oversight services to optimize revenue at the member level taking into consideration demographics, special statuses, LEP, LIS, LIPS, bid contract, and other factors.


Premium Billing

Provides plans the tools to successfully manage the premium and dues billing process for their Medicare members. Supports multiple billing schedules, various payment methods, the inclusion of a delinquency process based on CMS guidance, the integration of up-to-the minute member subsidies, and Late Enrollment Penalties (LEP), as well as complete tracking of prospective and retroactive enrollment.  Learn More.

Encounters (EDPS)

A comprehensive and feature rich Encounter Creation, Processing, and Submission solution that prepares and submits RAPS and EDS data to CMS for MAPD and ACA EDGE server requirements. Our solution effectively handles EDS processing from Preparation through Submission, to reject handling, and includes all levels of HIPAA validations, along with status dashboards for transparency, UI enabled fields for correction, and audit reporting. Encounter Data and Financial Reconciliation Reporting inclusive in the solution.


HCC Analytics

Examine all source data to identify suspect, missing, or incorrectly coded diagnosis codes – the foundation of accurate Risk Adjustment Scores. Helps plans optimize CMS revenue by identifying missing or potentially incorrectly coded HCCs based on historical trends, DMEs, Rx, and other complex algorithms. Analytical solution supports both MAPD and ACA LOBs.

 CMS Submissions

Let Dynamic manage your Health Plans CMS submission regulatory changes that will effect Operations, Risk Adjustment, and Reimbursement methodologies. Accurate CMS validations filtering logic and timely Enrollment, RAPS, and Encounters submissions to CMS with high expectance and avoidable reject rates.

Dynamic Healthcare Systems champions Medicare Advantage Organizations by fulfilling two goals: to relieve their burden of complying with the frequent and ever-changing government compliance and regulatory requirements and to help optimize their revenue and increase the quality of their governmental submissions.