Enrollment Compare Dashboard

Inbound Enrollments - For Insurance or TPA

Outbound Enrollments

• 834 File Loader Load 834 files with our scalable Enrollment Loader optimized to handle large load. Enrollment are loaded in Graph Database and available to process in seconds.
  

• 834 SNIP L1/L2 Validator SNIP L1 / L2 Validation of Enrollments before loading. Generate error file. The companion guide can be configured by Trading Partner, payer or provider. Companion guides can be changed on fly and tested with incoming files. Fully accept or Partial accept the Enrollment files
  

• 999, TA1 Response Create and send 999, TA1 based on SNIP L1 / L2 Validation results based on the Companion guide configuration. Outgoing 999 is attached to Graph Node and available to audit
  

• View Enrollments data View Enrollment data on HiPaaS UI. Check the file load status, Check the Enrollment validation status. Volume analysis. Find any Enrollment and coverage data. Drill down on validation error
  

• Create Enrollments Manually Create Enrollment in familiar formats screen
  

• Compare with Membership data - Full and Change file Configure rules to compare with membership data. Connect with membership data and compare member demographics, rate code, dual plans, coverage overlap, retro, term by absence, changes and more. Available for full file compare, audit file compare and change file compare. Handle multiple enrollments changes in one file

• Full File Compare Configure rules to compare with membership data. Connect with membership data and compare member demographics, rate code, dual plans, coverage overlap, retro, term by absence, changes and more. Available for full file compare, audit file compare and change file compare. Handle multiple enrollments changes in one file. Audit file compare
  

• Manage Validation Error Queues Manage errors queues and workflow for mismatch in compare and changes to be applied to membership systems
  

• Auto Correction and Auto Learning Configure and setup auto corrections of repeating data mistakes by membership data so that the Enrollments can be processed. Define workflow to hold the Enrollment for specific conditions. Views and Alerts Setup different business threshold alerts and notify business. Define analysis views by Provider, by trading partner, Submitter and others.
  

• Compare Demographics data Compare each incoming enrollment eligibility data with membership demographics to see difference
  

• Identify Transactions - ADD, Change, Audit, Term, Term by absence, Retro, Void Compare and identify changes to the membership data
  

• Coverage overlap handling Handle complex scenarios of coverage overlap, coverage split, EXT and INT segments , future coverages, retro coverage changes
  

• Rate code calculations Identify changes to rate codes and rate code calculations
  

• Dual plan analysis Identify dual plan changes and handling
  

• Get Enrollments API All the Enrollments are loaded are available to access from external systems by get Enrollment RESTful API based on filters like filename, enroll id, npi, status - accepted, reconciled all or by Enrollment type, date
  

• Generate ID Card Files Generate ID card files from Recent membership data changes based on new files
  

• EDI to FHIR mapping Prebuilt EDI to FHIR mapping to USCDI CORE - coverage