HEALTHsuite Advantage™Automate your information exchange with CMS.

Our Medicare Advantage CMS Integration Pack equips your organization with essential tools to streamline communications with the Centers for Medicare and Medicaid Services (CMS). This robust gateway facilitates the bi-directional exchange of information required for Medicare Advantage organizations.

• BEQ & BEQR, eligibility & compliance checks – ensures eligibility with CMS
• Automated enrollment / disenrollment submission to CMS
• DTRR processing of CMS response with configurable workflow and routing
• Revenue reconciliation with CMS (Premium Reimbursement)
  • Automated file loading & recon. with MMR, PPR, MPWR, LEP & No Premium Due
• LIS and LEP processing and integration with premium billing
• CMS COB / MSP file integration
• Claims / encounters submission (RAPS / EDPS)
• Encounter returns / corrections and resubmissions from CMS
• Integrated workflow and routing ensures compliance / timely resolution of issues
• Utilities to load and update CMS Fee Schedules

We are Medicare Advantage and CMS compliance experts

We are exclusively focused on government sponsored healthcare (Medicare Advantage, Managed Medicaid and Special Needs). As a result of this targeted focus, we are able to deliver the very best solutions for your CMS Integration and Medicare Advantage / Managed Medicaid needs.