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Enrollment and Billing

Connect to public/private exchanges with integrated enrollment and payment processing

Health insurance exchanges (HIXs) are all about e-commerce. Your health plan organization must ensure that enrollment, billing, tracking and collection are running smoothly as thousands of consumers browse for information, look for the best deals and start enrolling in public/private exchanges. A robust enterprise integration solution is key to your success.

Our Enrollment and Billing Solution enables secure, real-time quality transactions between health plans, providers, vendor, and federal/state systems. You will quickly enroll public and private models for individuals and group segments, and easily connect to the federally facilitated marketplace and state health insurance exchanges. Plus, you will execute data quality checks and payment integration and turn around premiums faster.

  • Streamline invoice processing and receipts
  • Ensure accurate payments and adjustments
  • Lower administrative costs
  • Increase cash flow
  • Improve accuracy and customer satisfaction
  • Manage an unlimited number of complex contractual and payment relationships
  • Easily introduce new consumer-driven retail products/plans.

Enrollment and billing with dell healthcare and life sciences
Enrollment and Billing

Our Services

Benefit from an enterprise integration solution offered for private exchanges to enable secure, real-time quality transactions between health plans, providers and federal/state systems.

Rating|rating
Rating and Quoting

Get a robust solution for quoting new prospects and delivering customized proposals. Calculate premiums based on a robust set of rate attributes. Generate real-time quotes for group and individual members. Take advantage of a flexible, rule-driven rating engine. Determine rates through a flexible rate matrix with multiple family tiering. Design and deploy new plans and bundles easily.

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Front Office|front Office
Enrollment and Eligibility Verification

Ease the administrative burden of benefits management and reporting and increase enrollment and participant satisfaction. Simplify group contract and enrollment processing. Support HIPAA 834, 820, 270 and 271 transactions. Synchronize data with internal and ancillary systems. Comply with PPACA enrollment policies and procedures. Reconcile member information with internal and external systems.

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Data Analytics And Reporting|data Analytics And Reporting
Customer Service Representative Dashboard

Provide comprehensive information about a subscriber and their eligibility, billing invoices, payment history and electronic payments (EFT/Credit Card/Debit Card/Cash Card). Manage customer contacts and issue resolution. Manage member electronic payment configuration and schedule. Gain a single view of member/employee information. Manage appeals and grievances according to policies. Review billing and payment history.

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Consulting And Program Design|consulting And Program Design
Interfaces and Integration

Get efficient health plan system functionality with seamless integration across federal systems and state agencies and other vendors. Effectively manage and analyze member interactions and data throughout the life cycle. Integrate with ancillary account receivable and general ledger systems. Execute real-time data integration – scalable to meet high volume. Interconnect seamlessly across multiple exchanges. Take advantage of industry standard integration.

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Strategic|strategic
Compliance and Reporting

Support accurate tracking and reconciliation of payments through a series of standard reports meeting most of the required reports used by health plans. Generate compliance and regulatory reports. Track metrics through a dashboard view. Generate enrollment, participation and account reports. Provide accurate coverage information to bill accurately for services. Ensure accuracy by integrating a variety of transactional and functional data from key business systems.

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Premium Billing and Payment

With full-featured billing and payment, you can rely on accurate revenue recognition and receivables management. Produce all of the data needed for billing and remittance. Process annual/retroactive enroll and ad-hoc rate changes and updates. Generate individual, group or split bill to facilitate billing premiums and fees across multiple entities. Manage complex billing and payment plans. Process electronic/paper forms of payment.

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Consolidated Data And Workflow|consolidated Data And Workflow
Quality Assurance and Testing

Multiple test disciplines and practices can integrate customer-specific test requirements into the overall test strategy. Provide a full range of testing services. Enable strategic test consulting. Execute proven test processes, strategies and governance models. Provide specialized testing services in emerging areas such as mobile, analytical, security, and agile. Deploy ready-to-use innovative test solutions and frameworks.

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Learning Library

A Sophisticated Solution For A Small Hospital|a Sophisticated Solution For A Small Hospital
Accelerate Success with Value-based Care Learn More

Our white paper explores the ways advanced technology and outsourcing improves healthcare service and builds patient trust.

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