Enrollment & Eligibility Platform
Streamline your processes and increase member satisfaction

With the cloud-based Enrollment Plus platform, payers can automate eligibility verification, export and in-load BEQ files to/from CMS, in-load Election Transaction Reply files (TRRs) for Medicare, in-load rosters from employer groups, state and federal entities for Commercial, Exchange and Medicaid, easily export enrolled members into their core claims system, and generate correspondence—all while maintaining compliance, decreasing costs, and improving member retention. In addition, members have access to online customer service tools which empower them to help themselves, while reducing call center volume, speeding up issue resolution, and transforming customer satisfaction.

Rules-Based Enrollment
Expedite enrollment, validate and edit election data, and improve consistency across all channels with our adaptable rules engine.

Exception Workflow Routing
Manage exceptions and assign issues to enrollment staff based on selected criteria for quick resolution.

Time-Saving Tools for Call Center Staff
Connect essential information and empower call center staff to resolve customer service issues quickly without sacrificing control

Supports Multiple Channels and Formats
Ingests and transforms applications in virtually any format, including 834, flat files, xml files and scanned/digitized paper enrollment forms.

Validate Member Data
Ensure that member data is accurate with real-time validation.

Self-Service Tools for Members
Members can upload claims, receive error notifications, correct errors and access online paths to resolve most common call center issues

Engage Your Members

Deliver an industry-leading, tailored member experience online, on mobile, over the phone, and even via mail with user-friendly member portals, customizable modules, and reliable API’s
  • Benefits & Member Data APIs
  • View and Manage Claims
  • Vendor Integrations (HSA/FSA, telehealth, wellness, rewards)
  • Manage Communication Preferences
  • Pay & Manage Automated Premium Payments
  • Edit Member Details
  • Request / Print ID Cards
  • Treatment Cost Estimator