Enrollment and Billing

Improve payment accuracy with streamlined enrollment and billing

Industries/ Healthcare & Life Sciences/ Health Plans /Enrollment and Billing

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 can quickly enroll individuals and groups for public and private models, and easily connect to the federally facilitated marketplace and state health insurance exchanges. Plus, you can execute data quality checks and payment integration and turn around premiums faster.

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.

We can help

Streamline invoice processing and receipts to ensure accurate payments and adjustments

Lower administrative costs and increase cash flow

Manage an unlimited number of complex contractual and payment relationships

Easily introduce new consumer-driven retail products/plans

Our solutions:

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.
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.
Customer Service Representative Dashboard
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.
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.
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.
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.
Quality Assurance and Testing
We provide a full range of testing services and can integrate customer-specific test requirements into multiple test disciplines and practices for a robust test strategy. We can deploy ready-to-use test solutions and frameworks and also provide specialized testing services in emerging areas such as mobile apps, analytics and security.
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