Medicare Advantage and Medicare Part D

Revenue management, compliance and the customer experience all start with enrollment operations. No matter the software solution employed, plan staff need solid training on fundamentals and details of enrollment and reconciliation events to ensure efficient, accurate and compliant operations.

ATTAC Consulting Group provides enrollment and reconciliation training including:

  • Beneficiary eligibility requirements
  • Election periods and effective dates
  • Basic enrollment process
  • Reconciliation processes and discrepancy management
  • TRR and TRC management
  • Effective use of Beneficiary Eligibility Query (BEQ)
  • Special Election Periods
  • Late Enrollment Penalty (LEP) and Creditable Coverage processes
  • Billing processes
  • SNP enrollment validation and coordination with state Medicaid data
  • Retroactive enrollment management
  • Enrollment and reconciliation monitoring & auditing programs

Health Exchange (HIX) Enrollment and Reconciliation  

Consumer engagement and satisfaction in the HIX marketplace starts with solid enrollment, reconciliation and premium billing functions. For federal and state-based Exchanges (HIX), the enrollment and reconciliation process continues to evolve with countless scenarios to address along separate tracks and to ensure reconciliation with the Exchange. Regardless of software used, each possible event for individual and SHOP enrollees requires discreet process handling and validation. ATTAC Consulting Group has developed numerous tools to support HIX enrollment and reconciliation operations, including:

  • Individual and SHOP event scenarios to drive end-to-end process handling
  • Critical process control points to support effective process monitoring
  • Performance, compliance and operational metric solution frameworks