End-to-End Enrollment Processing for CMS & MAPD Plan Systems:
SyncEnroll™ is an end-to-end enrollment processing solution with API integration ability for CMS and MAPD plans systems. It provides automated processing for clean enrollment applications, by applying advanced business rules to identify, route, and track enrollments with errors through queue-based workflows. Enrollments with errors are evaluated using CMS guidelines to ensure proper handling and timeliness requirements. (In Development)
Other key features and functions include:
- Enrollment Intake options—paper, broker, plan OEC, CMS OEC (API), and telephonic
- Optional Online Enrollment Web Form for broker/member access
- Beneficiary Eligibility Query (BEQ) processing including Real-Time BIC-BEQ API processing for eligibility verification at point-of-sale
- Election Period Rules identify/verify election period based on BEQ results and enrollment information
- Automated Request for Information (RFI) Logic places beneficiary in RFI status, triggers correspondence, and tracks enrollment application during RFI period
- Automated RFI Denial Process is invoked if additional information is not received
- RFI Call Report captures enrollment applications where only the election period is missing
- Automated Accretion files sent daily to CMS ensures timely processing.
- AEP Unsolicited Report captures enrollment applications from Oct 1-14 to ensure appropriate guidelines have been met
- Enrollment Dashboard provides insight into overall volume and plan-type.
Tracks enrollments by application-received signature dates and CMS accretion - Member Correspondence/Letter Management enables letters to be triggered based upon variable factors such as contract, PBP, plan type, letter type, etc.
- Post-enrollment processing and maintenance combines enrollment updates such as plan changes, disenrollments, cancellations, along with demographic, special status, premium payment, and address updates
- Late Enrollment Penalty (LEP) Attestation Processing provides gap identification, Attestation mailing, tracking, and submission to CMS
- Best Available Evidence (BAE) & Low-Income Subsidy (LIS) processing
- Pharmacy Benefit Manager (PBM) Reconciliation
- Part C & D (PBM) Claims Integration – eligibility and member status data feed
- DSNP enrollments built-in business logic includes state eligibility verification and LIS deeming/loss process