1Data Sheet | Enrollment ManagementDS

Enrollment Management

Introduction

It goes without saying that members are the lifeblood of all health plans. Therefore the health plan’s ability to enroll members in a cost-effective, efficient and timely manner is mission critical. However given the myriad of enrollment partners a health plan can have, streamlined enrollment is a major challenge. Add in the collaboration and visibility issues that plague most health plans and a scenario exists that not only exacerbates administrative and IT TCO costs but can lead to revenue loss as well.

Addressing these challenges requires a flexible, end to end enrollment management lifecycle solution designed to address the needs of health plans today and in the future (as opposed to stop-gap measures). Edifecs Enroll-ment Management delivers a set of comprehensive, flexible capabilities designed to consolidate enrollment partner operations and processes, enhance automation and drive improved employer group visibility and collabo-ration. These capabilities promote the reduction of costs, improve group and member satisfaction and mitigate revenue loss.

Why Edifecs

• Market-tested inclusive of validated scalability

• Built upon the market-leading EDI platform

• Leverage a solution built specifically for the group enrollment market

• Consolidate enrollment processes across all channels and partners

Capabilities

• Full file enrollment comparison and processing

• Consolidates enrollment intake channels across LOBs

• Coordinates enrollment with outsourced vendor health plans (e.g. dental, vision, behavioral health, etc.)

• Empowers employer groups and other partners through self-service onboarding workflows and maintenance fallout resolution

2DS Data Sheet | Enrollment Management

Benefits

Reduce administrative costs

Enable a best-in-class partner experience

Reduce IT TCO

Features

• Account Management User interface specifically designed for enrollment operations personnel to track and support assigned employer group accounts

• Reporting and visibility Graphical summary dashboards with drill down capabilities for insight into transactional activity, transaction status tracking, and workflow aging

• Account Portal Onboard new employer groups and partners quickly through self-service connection testing – including prescribed maintenance scenarios in agreed upon electronic format

• Full file maintenance processing Compare regular scheduled maintenance files from employer group and vendor partners to identify updates and create appropriate change, add, term transactions for downstream systems

• Full file audit processing Compare monthly or quarterly employer group and vendor partner enrollment Audit full-files to identify discrepancies and resolve through collaborative workflows

• Supports multiple inbound and outbound formats Fully validates inbound and outbound transactions against marketplace published standards, including non-834s, to ensure compliance

• Account Management Easily identify scheduled activity for assigned accounts and open workflow items. • Account Portal Secured web portal access for employer groups and partners to view and resolve enrollment transaction fallout.

• Full file processing Compare marketplace monthly audit files against enrollment source of truth to identify and resolve discrepancies

• Supports multiple inbound and outbound formats Single solution that supports multiple 834 variations across FFM/SBMs and private exchanges as well non-834 formats

Edifecs Inc. is a global healthcare software company committed to improving outcomes, reducing costs, and elevating value of healthcare for everyone. Edifecs delivers the industry’s premier IT partnership platform to providers, insurers, pharmacy benefit management companies, and other trading partners. By mobilizing its leading solutions at the front end of the healthcare information pipeline, Edifecs provides a unified platform for partners to flexibly pilot and scale new initiatives using their existing enterprise system. Since 1996, hundreds of healthcare customers have relied on Edifecs partnership solutions to future-proof their leading initiatives in the midst of a dynamic healthcare landscape. Edifecs is based in Bellevue, WA, with operations internationally. Learn more about us at edifecs.com.

© 2016 Edifecs Corporation. All Rights Reserved. www.edifecs.com PN: DS0473.2016.11

• Full-file processing Perform comparison between marketplace enrollment monthly audit files and internal membership within the EDI channel and regardless of number of membership systems

• Single channel for multiple lines of business Single solution for processing all enrollment transactions through configurable business rules driven by source (public exchange, private exchange or direct portal, employer, Medicaid, etc.), line of business (large group, small group, individual, etc.), and target membership system.

• Fully scalable (both horizontally and vertically) solution that scales as membership grows or additional LOBs are enabled Scales both horizontally and vertically to efficiently support initial membership as well as strategic growth targets; underlying Edifecs Smart Trading transaction processing platform is proven to support millions of transactions daily