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Simplified Enrollment System

Peace of mind with automated loading of 834 and 820 files. Advalent fully complies and translates files to exchange 834 format. Advalent proactively implements all changes from CMS. Advalent auto balances transactions with load summary.

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Membership System

Advalent enrollment is workflow enabled. All exception records are placed in appropriate work queues for resolution. Multiple queues and workflows can be defined for easy management of exceptions and their resolutions.

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Membership Reconciliation

Advalent auto reconciles memberships with records from exchange and changes made within the system.

Smart Enrollment Capabilities

  1. Customizable ERL (Enrollment Rule Library)
  2. PreSubmission Validations
  3. Autmated Electronic Enrollments Management
  4. Manual Applications Management
  5. Enrollment Exception Queue Management
  6. Skill Based Routing
  7. Enrollment Lifecycle Status Automation
  8. Conditional Overrides Automation
  9. Enrollment Member Portal Capabilities
  10. Enrollment Employer Portal Capabilities

Dynamic Member Management

  1. Streamlined Add, Term and Change Workflows
  2. Smart PCP, Address, Plan, Riders and Payment Management
  3. Benefit and Provider Management
  4. Automated Rules Based Correspondence
  5. Accurate Dependent Management
  6. Broker Verification
  7. Accurate ID Card Issuance
  8. Coverage Management
  9. Member COB, LIS and LEP Processing

Connectivity

  1. Market Place / Exchange Connectivity
  2. CMS Connectivity
  3. Claims Processing System Connectivity
  4. Delegated Entities (Pharmacy/Chiro) Connectivity
  5. Third Party fulfillment Vendor Connectivity (ID Card/Plan Documents)
  6. Self Service Portal Connectivity
  7. Bank Connectivity
  8. Call Center Connectivity
A new approach in delivering healthcare tools

Advalent is reinventing the way healthcare payer and provider technology is acquired, delivered, used and paid for. We envision a world where plans and providers can easily, quickly and affordably leverage the right technology to succeed in the ever-changing healthcare environment. Our innovative, flexible and scalable cloud-based platform reduces initial system and ongoing support costs making it easy for all users to inexpensively process and analyze healthcare data.

Transforming healthcare IT

As pioneers in the transformation of technology solutions for U.S. healthcare organizations, Advalent delivers an unprecedented level of affordability and efficiency. Advalent team has in depth payer and claims experience and a thorough understanding of the technical and business requirements mandated by the Affordable Care Act (ACA), Centers for Medicare and Medicaid Services (CMS) and Accountable Care Organization (ACO) requirements.

Configurable solutions for quick deployments and cost-savings
  • Promoting standardization by driving the re-usability of technology platforms and solutions.
  • Developing default implementation patterns that providers and payers can customize for their unique business needs.
  • Creating tools that reinforce standards-based design and implementation.
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Low Implementation Cost
Low Total Cost of Ownership
Seamless Scalability
Service Level Agreements