Health plan member management in one unified solution
Simplifying member management for Medicare Advantage plans
Using intelligent automation and real-time data management, Reveleer’s Member Management Solution empowers health plans to streamline operations, reduce costs, and enhance member satisfaction—all in a single solution.
Smart member enrollment
Reduce costs and maintain compliance by automating member eligibility verification, correspondence, maintenance, enrollment, and election submissions to CMS.
Streamlined premium billing
Access a single, detailed source to manage billing activity, quickly calculate beneficiary premiums and dues, and automatically generate custom invoices and statements.
Revenue reconciliation
Seamlessly reconcile data that impacts the calculation of earned revenue and compare the data to CMS’s data to avoid unnecessary penalties, manage attestations, and manage cash flow.
Where Medicare member lifecycle management meets excellence
Reveleer’s powerful Member Management Solution is purpose-built for efficiency, accuracy, member satisfaction, and compliance. Discover how our unified solution empowers your team with tools they can trust.
Unlock the power of our unified Member Management Solution
The foundation of health plan success is built upon a comprehensive member management system. Our innovative technology offers a comprehensive solution that seamlessly unifies enrollment, premium billing, and revenue reconciliation.
40% decrease in workload
Ensure faster onboarding and improve member satisfaction by automating manual processes and expediting enrollment for all members.
9-point reduction in inaccurate data
Gain real-time visibility into payment discrepancies and retroactive adjustments. One client reduced inaccurate member data from 12% to 3% within a year.
75% fewer manual errors
With lift-and-shift cloud deployment, experience the results of unified Member Management in no time. Seamless implementation enables faster operational efficiency and fewer manual errors.
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Key benefits of Reveleer's Member Management Solution
Real-time data management
Reveleer’s Member Management Solution consolidates disparate data sources into one centralized system designed specifically for Medicare Advantage plans. This approach provides real-time insights across enrollment, premium billing, and revenue reconciliation that plans can use to improve member satisfaction and care coordination.
Automation to simplify enrollment
Streamline time-intensive workflows by using intelligent automation to automate enrollment processing, premium calculations, and revenue reconciliation. Reveleer’s Member Management Solution helps MA plans reduce transaction reply report processing times as well as manual errors to ensure precision and compliance.
Proactive compliance for CMS confidence
Stay audit-ready with built-in compliance tools that ensure adherence to evolving CMS regulations. Automated workflows simplify submissions, validations, and reporting while reducing the risk of penalties. Customers rely on Reveleer for error-free CMS submissions, facilitating seamless operations while protecting member coverage.
Health Plan Guide
Turning chaos into clarity: achieving financial accuracy in MAPD reconciliation
With new CMS rules and shifting risk models, even small mistakes can result in millions lost or expose your plan to costly penalties. This comprehensive guide offers a blueprint for mastering compliance, preventing revenue leakage, and staying audit-ready.
Smarter technology, superior results for member management
Intelligent data acquisition, at scale
Reveleer extracts 96K+ pages of structured and unstructured clinical data hourly from disparate systems to deliver real-time insights for value-based care.
EVE™, Evidence Validation Engine
EVE guides abstractors to member insights linked seamlessly to clinical source documentation to optimize the clinical review process.
Patient Index, a holistic view of care
Patient Index is a consolidated collection of linked patient data mined from multiple sources and systems for a unified view of patient care across member management, risk adjustment, and quality improvement.
The basics of health plan member management
What is a member management system?
Member management solutions empower health plans with the technology they need to complete critical member data functions and reporting to CMS.
Reveleer’s Member Management Solution takes this a step further, automating critical processes including enrollment, premium billing, and revenue reconciliation for enhanced efficiency and CMS compliance. By leveraging intelligent automation workflows and real-time data insights, the solution delivers accurate revenue calculations, streamlines operations, and enhances member satisfaction. It also provides sophisticated reporting dashboards to track payments, forecast revenue, and identify discrepancies early.
Why is effective member management foundational to value-based care?
In a value-based care environment, health plans must prioritize efficiency and revenue growth to succeed. Streamlining enrollment and billing operations saves hours of administrative time and frees up staff to shift their focus to strategic initiatives. Additionally, automating billing improves revenue transparency, while expediting member enrollment facilitates quick access to services that improve health outcomes.
How does the implementation of the Member Management Solution work?
Reveleer simplifies the implementation of our Member Management Solution using lift-and-shift cloud deployment. The entire process is quick and seamless for health plan staff, minimizing disruption to operations.
Additionally, Reveleer's intuitive and user-friendly interface ensures that staff can easily navigate the software with minimal training, reducing onboarding time and accelerating adoption. Health plan teams benefit from streamlined workflows that require fewer setup steps, allowing them to be up and running in no time.
With Reveleer’s dedicated support and hands-on guidance throughout the deployment process, health plans can achieve faster time-to-value while empowering their teams to focus on improving member care and operational efficiency.
Is Reveleer’s Member Management Solution CMS and HIPAA-compliant?
Yes, the entire Reveleer Platform is compliant with CMS, HIPAA, and other regulatory bodies. We designed our platform workflows to align with CMS requirements, and our team keeps a close eye on the ever-evolving regulatory landscape to ensure processes from data acquisition to CMS submissions meet the highest regulatory standards.
What other solutions does Reveleer provide to support success in value-based care?
In addition to our powerful Member Management Solution, Reveleer offers a single platform for value-based care that incorporates Quality Improvement, Clinical Intelligence, and Risk Adjustment solutions into the same unified platform, no disconnected systems to manage.
Related Resources
Learn how our Member Management solution makes all the difference in unifying data.
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Five strategies for MAPD revenue reconciliation success
Discover 5 proven strategies to streamline Medicare Advantage (MAPD) revenue reconciliation, ensure CMS compliance, and prevent revenue leakage with AI and automation.
