Five strategies for MAPD revenue reconciliation success

Revenue reconciliation for Medicare Advantage Prescription Drug (MAPD) plans has changed substantially. The requirements used to be more straightforward—verify enrollment, check member status, and confirm CMS payments. Most plans could accomplish this easily enough with spreadsheets.

However, spreadsheets aren’t up to the task of revenue reconciliation in 2025. The current complex, multi-layered process requires MAPD plans to go ten steps further. Increased Medicare Secondary Payer identification, new reporting mandates, and growing member complexity have made revenue reconciliation more complicated—and high-stakes—for MAPD plans. Now, you need a precise and efficient way to conduct revenue reconciliation that scales as you grow while keeping up with complex regulatory requirements. Without solid success strategies, MAPD plans risk losing revenue and facing penalties for non-compliance.

Five strategies all MAPD plans should consider for revenue reconciliation

Fortunately, advances in technology including intelligent automation and artificial intelligence (AI) in healthcare can dramatically transform revenue reconciliation for MAPD plans. Technology’s ability to extract, integrate, and make sense of large volumes of data can transform the entire process. Here are five strategies MAPD plans should consider when leveraging technology to streamline revenue reconciliation, making the process more accurate, efficient, and compliant.

Strategy #1: Implement robust system integration.
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At the plan level, do you have access to all relevant member data—and is it connected? Do you have the ability to run analyses based on data from various platforms? The first success strategy is all about enabling seamless connectivity across your platform so that you have consistent and accurate data flow.

Strategy #2: Verify your data stream configurations.
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Make sure you have strategies to verify that your data is flowing seamlessly and to measure the accuracy of your data. AI-powered technology can support this, helping you identify any gaps or anomalies in your data.

Strategy #3: Foster collaboration across your teams.
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When it comes to revenue reconciliation, expertise across multiple teams is a huge component of success. If your operations, IT, finance, revenue, and compliance teams do not all have a seat at the table, reconsider your workflows. With the right revenue reconciliation technology, MAPD teams can easily collaborate, sharing dashboards and reports to increase visibility into key metrics.

Strategy #4: Increase the accuracy of your accruals and attestations.
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Do your financial projections align with actual revenue outcomes? Using advanced analytics and automation tools, MAPD plans can effortlessly increase the accuracy of accruals and attestations. When these calculations are supported by thorough documentation and real-time data validation, they help you comply with CMS requirements and reduce the risk of audits.

Strategy #5: Dedicate processes to monitor and manage retroactive changes.
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Create specialized teams or systems to analyze historical claims data and flag discrepancies early on. This will allow you to respond more proactively to CMS payment revisions, make timely updates to revenue forecasts, and reduce the impact of unexpected retroactive changes on your plan’s financial performance.

Explore Reveleer’s Revenue Reconciliation product for MAPD plan success

MAPD plans need powerful technology—and an experienced technology partner—to simplify revenue reconciliation and ensure compliance. Doing so will improve the consistency and integrity of your data and allow you to effortlessly scale as you expand your member base.  

Reveleer’s powerful Member Management Solution can support you as you take the five steps above: integrating your data, validating data streams, facilitating collaboration, increasing accuracy, and dedicating workflows for retroactive changes. The result is more efficient and accurate revenue reconciliation—and reduced risk of penalties for non-compliance.  

One Midwest health plan manager put it this way: “With Reveleer, there’s so much automation set up that when revenue reconciliation hits, we’re ready. We don’t have to wait for anything. We can go right to it and see everything we need in one place and in real time."

Interested in learning more about how advanced technology can power your revenue reconciliation process? ⁠Watch our webinar, “MAPD revenue reconciliation and data integrity: A proven playbook for success,” and develop a plan for transforming your revenue reconciliation process from overly complicated to under control.