MarketProminence (MP) Enrollment Solution
MedHOK’s MP Enrollment module comes out-of-the-box fully compliant with CMS Medicare and state Medicaid rules and can be easily configured to meet business requirements and workflows. This solution offers add-on modules for Financial Reconciliation and Premium Billing, providing the most rigorous system in the industry to ensure compliance and timely processing for enrollment, reconciliation, and billing procedures. The solution also allows health plans to reconcile enrollment and payment at the member level to remediate differences and ensure maximization of revenue as well as track expected revenue moving forward at multiple plan levels.
Customers use the solution to:
- Intake electronic and paper applications and validate for required information
- Submit eligibility information and receive responses from various regulatory/governmental authorities
- Maintain ongoing eligibility updates and downstream required information to subcontractors and plan systems
- Send compliant correspondence to members about enrollment and throughout the calendar year
- Intake various enrollment and financial files form regulatory/governmental authorities to reconcile enrollment and payment information
- Process all member maintenance functions including: address changes, premium withhold updates, plan benefit package changes, member disenrollments, and other required member maintenance functions
- Process Daily Transaction Reply Reports (TRR), using a sophisticated business rule engine that provides automation and memorizes multiple code combinations
Have You Considered …
With MP Enrollment, you may also want to manage related functionalities on one platform to ensure compliance, improve efficiency and productivity, and deliver better quality care. Consider adding these MedHOK solutions:
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