Enrollment Plus: Turnkey enrollment and membership system
Automate enrollment management with exception workflows and membership reconciliation

Advalent Enrollment Plus offers a highly automated Enrollment model which promotes operational efficiencies, allowing plans to achieve simplicity and cost efficiency without compromising program integrity. Advalent enrollment plus manages automated processing of inbound/ outbound enrollment transactions (CMS/ Exchange/ Commercial/ Custom), coupled with configurable and integrated workflows for exception management. Advalent Enrollment Plus allows further flexibility by offering multi-channel access to different self-service tools which seamlessly integrate across multiple health insurance platforms. The solution permits easy customization to adhere to, state’s rules and program designs with some of the immediate outcomes being reduced manual labor, increased data accuracy & record-processing success and improved customer satisfaction.

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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