Medicare Advantage

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With the rapid expansion of the Medicare Advantage market, there are myriad opportunities for plans to expand their market share—that is, as long as they can successfully navigate the challenges of enrollment management.

To capitalize on these opportunities, health plans need to be efficient, scalable, and compliant. And with the Edifecs Enrollment Hub, they can be.

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strengthen

  • Automate generation of eligibility request and response files
  • Seamlessly reconcile ESRD, CMS, and subsidy data
  • Simplify Medicare Supplement (Medigap) administration

Boost your processing power

Automate, reconcile, and validate data for more efficient enrollment processing.

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communicate

  • Generate and preview member-, group-, and application-level letters
  • Simplify rejection letter creation
  • Improve status reporting for enrollments and disenrollments

Deliver fast, compliant correspondence

Reduce administrative burdens with automated letter generation.

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support

  • Integrate all membership systems
  • Provide enriched data for downstream systems
  • Transmit file-agnostic data to downstream partners

Facilitate downstream success

Give downstream partners the high-quality data they need to thrive.

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solidify

  • Streamline Transaction Reply Report (TRR) processing, validations, and workflows
  • Facilitate MARx file compliance with near-real-time MARx entitlement data
  • Provide tracking and updates for each submitted and received transaction

Stay compliant via CMS integrations

Robust reporting provides more actionable insights and enables regulatory compliance.

Find out how we can support your health plan's performance.