Enrolling members into government programs is complex and involves layers of regulatory requirements. Time wasted with manual processes can impede staff productivity and profitability.
Getting the timing, language, premium amount, and CMS required language for member correspondence can be difficult and, if not done correctly, can initiate potential audits.
Reveleer’s Enrollment and Eligibility solution provides health plans with a highly automated solution that utilizes extensive pre-submission validations resulting in:
System validations are done to ensure the data entered or batch submitted is formatted correctly (numbers in number fields, alpha characters in alpha fields, etc.). Eligibility validations are done via Batch Eligibility Query (BEQ) based on the information on the election. The system includes business rules regarding when certain elections can be used and what corresponding effective dates are viable.
Our member correspondence makes it simple as all CMS model letters are built within our system which helps automate the majority of your correspondence with intervention only required on exceptions found by our analytics. You have the ability to: