HEALTHsuite Advantage™Medicare Advantage Enrollment, Billing and Reconciliation

Plans already administering Medicare Advantage and those planning to launch a new offering face different challenges:

• Some health plans prefer a phased approach rather than replacing their core systems all at once
• Others may use their current claims platform but need additional functionality to meet CMS requirements for enrollment, billing, and reconciliation

HEALTHsuite Advantage’s Enrollment, Premium Billing, and Reconciliation solution can function independently or integrate with any claims system (ANSI x12 834, or 834 mapped to proprietary format, etc.). Whether standalone or integrated, our Enrollment, Premium Billing, and Reconciliation solution is designed for quick implementation and configuration to handle Medicare Advantage enrollment and bi-directional communications with CMS.

HEALTHsuite Advantage is pre-configured to automate enrollment, billing, and reconciliation. Its accelerated implementation significantly reduces time to market, saving your organization both time and money. With our extensive experience in Medicare Advantage administration and CMS compliance, we provide the keys to elevating your Medicare plan to the next level.

For an enhanced level of service, we offer BPaaS services for Enrollment, Premium Billing, and Reconciliation, which includes:

• Enrollment and eligibility management
• Premium billing and payment processing
• Financial reconciliation
• Customer service/call center management
• Mailroom and fulfillment services
• Reporting and compliance