Medicare Enrollment and Eligibility

Optimize Revenue, Minimize Compliance Risk

Reduce your costs and maintain compliance by automating your member eligibility verification using the CMS-endorsed and recommended BEQ process. Automate your letter generation, election adjudication (up to 98% adjudication rates) and TRR processing.


Features

  • Accept MA-PD, MA and PDP enrollment data
  • Export enrollment/disenrollment, correction and change transactions for submission to CMS
  • In-load weekly/monthly Election Transaction Reply Files (TRR)
  • Export BEQ files for submission to CMS
  • In-load BEQ reply files from CMS
  • Export approved/eligible members to core claims system
  • Utilize manual entry of election form data
  • Import data files containing election transactions
  • Utilize the flexible rules engine to edit election data for errors and work flow
  • Manage exceptions by creating work items placed in work queues
  • Allow examiners the ability to review/document and create correspondence and correct election data
  • Build correspondence packages from stored Word document template libraries
  • Automatically initiate correspondence manually or from the rules engine
  • Export CMS ready files for BEQ submissions, enroll/dis-enroll and corrections files
  • Export enrolled members into a core claims system
  • Export queued correspondence for electronic print and fulfillment