The Task:

To develop an organized process that well defines the Medicare members’ enrollment procedure into the HMO. This enables to have a synchronized workflow involving members to send applications, tracking and screening them, and thereby verifying their eligibility to generate approval letters.

The Challenges:

To be able to provide an effective and centralized solution by converting the client’s manual, incompetent enrollment process into a structured workflow.

The Solution:

Binary Spectrum developed a web enabled solution that details out the enrollment application process with harmonized procedure. The HMO campaigns and conducts events in order to create awareness for enrollment. This enrollment process takes place during October to January every year. Agents take part as an internal source and brokers are contracted as a third party for promotion. Once the collection of application is done either through agents or brokers as an offline workflow, it is followed by the online processes. This facilitates the client to have an automated record of the following workflow:

• Collecting the Medicare applications
• Verifying Batch Eligibility Query (BEQ)
• Approving the applications
• Enrolling applications into the Client’s database
• Generating Transaction Reply Report (TRR) file
• Generating approval letters to members based on TRR

Each course of action either proceeds or a flow back status is indicated based on its respective criteria fulfillment. This helps in checking out any errors existing at each stage, which needs to be rectified.

The Result:

The client is now extensively using our well defined and organized Medicare enrollment process. Being a web enabled comprehensive solution; the client has access to ease and efficiency in their work as well.

look at other HMO case studies

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• Managing website portal with regulatory content for compliance
• Standard reports for CMS and Sponsors
2. EDI: Business to business platform for bulk transactions
3. Medical research administration for Medicare members
4. Online Analytical Processing
5. Health Reimbursement Arrangements

Well if you are interested in outsourcing software development or would like to find out more about our services and offerings, please get in touch with us. You might want to send us a mail, or simply contact us at info@binaryspectrum.com. A senior member of our customer engagement team will get in touch with you within 24 hours.