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Enrollment / Reconciliation

ENROLLMENT PATHWAYS MODULE
Slash application-processing time by up to 80 percent.

Now you can achieve nearly perfect new enrollment success rate and reduced enrollment-related discrepancies.  It’s all the result of the CMSGateway Enrollment Module that dramatically reduces Medicare application processing.

  • Minimize the time it takes to determine members’ enrollment eligibility with real-time eligibility and entitlement queries as opposed to standard batch processing.
  • Get instant feedback on whether the application is complete with built-in plan-specific Medicare Enrollment and Disenrollment validations.
  • Create virtually error-free membership accretion files and dramatically reduce your rejection rates.
  • Experience much higher efficiency since information is fully integrated with auto-populated enrollment screens.

CMSGateway is a solution whose time has come. It’s head-and-shoulders above other membership-and-payment process resolutions

RECONCILIATION MODULE
Cut down on time-consuming research-and-rework time.

There’s nothing quite like the Reconciliation Module to automate, streamline and integrate your reconciliation processing. With daily, weekly and monthly reconciliation, you can rest assured that plans remain in compliance with CMS and the accuracy of your membership, enrollment and payment data is assured

  • No need to access multiple applications: CMSGateway provides a single point of data correction so you can quickly correct discrepancies such as demographic, plan or special status.
  • Great for research and auditing purposes: Files and data are archived in a structured database and readily available at both plan and member levels.
  • Advanced member reconciliation functions: You can perform daily membership reconciliation, CMS-to-plan discrepancy identification and resolution (SCC, PBP, LIS, demographics, etc.) and CMS special-status reconciliation (automated daily maintenance TRR processing, HIC changes and more).
  • Advanced payment reconciliation functions: In addition, the Reconciliation Module enables you to set up and monitor monthly payment files (MMR); perform member, PBP, contract and MCO-level ledger reporting, and management reporting for payments and adjustments.

With fewer discrepancies and more efficient discrepancy resolution, you can significantly reduce the resources required to perform time-consuming research and rework. And that translates to added cost-effectiveness.

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