Medical benefit enrollment has multiple federated restrictions on open enrollment period and qualifying conditions. There are multiple enrollment & premium management systems and forms (Employer, Broker, Direct, Federal Marketplace, Commercial Marketplace, Medicaid, Medicare, CHIP) of enrollment. Once the enrollment is completed, then management of enrolled members is maintained from its originating system and records are passed to Insurer’s claims & Benefits management system so there are no interruptions in coverage.
Having to deal with multiple originating systems and various data formats creates complexities in business rules, schedules, acknowledgement of receiving records, error reports, and duplicate records, while managing the workflow becomes a cumbersome and costly process for insurers.
EIXSYS has developed a process for multiple insurers, which connects various systems on a unified platform that parses various formats of inbound files into a single enrollment business rule and report generation engine. The solution allows consumers to obtain real-time quotes, along with a reference number to be conveniently used during the enrollment process.
As quotes could be obtained immediately, there was higher overall enrollment for the plan, and higher consumer satisfaction. The reference number provided to the member is linked directly to his or her information to be used during enrollment, which in turn reduced errors. There’s also the added convenience due to the fact that consumers can link payment information inside the portal.