Eligibility and Enrollment
A Complete Eligibility and Enrollment Solution for beneficiaries
Schedule a DemoMedAdvantage360
E&E360
- Real-time MBD Access with CMS MarX
- Rapid Enrollments due to expedited validations
- High first pass acceptance rate
- Enrollment through multiple channels
- Batch processing to handle large volume of data
Wipro’s Eligibility and Enrollment (E&E360) product is a game-changer for member enrollment process in Medicare. The system seamlessly integrates CMS provided data into our platform and utilizes CMS-provided edit criteria and MBD validation to ensure accurate transaction status determinations.
For Medicare eligibility verification, it leverages our cutting-edge APIs to access real-time member data from CMS, such as ESRD status, Medicare eligibility dates, LIS, and LIC. Our system supports both online and batch processing of individual applications.
E&E360 makes it easier and convenient for health plans to edit, validate, and submit enrollment-related transactions to CMS. Notably, the validated transactions submitted to CMS exhibit an exceptional first-pass acceptance rate of 99% or higher.
Don’t settle for manual verification methods that are prone to errors and delays. Choose Wipro’s Eligibility and Enrollment (E&E360) solution, that offers faster, simpler, and more reliable verification processes that can improve member satisfaction.
Accurate & Swift member enrollments
Health Plans
benefitted
Increase in overall operational efficiency
First Pass
Acceptance Rate
E&E
Real-time eligibility verification with CMS MarX through APIs
24/7 Availability
Round-the-clock availability of both data and applications to ensure uninterrupted access and seamless operations
Minimal Downtime
Avoid CMS BEQ Marx downtimes that may impact operations. Carry out the eligibility checks seamlessly and enroll members efficiently
Real Time Editing & Processing
Real-time data validations are done. The data can be edited immediately and resent to CMS for eligibility check ensuring faster enrollments.
Batch Processing
Efficient processing of high volumes of data to provide a scalable and robust infrastructure and carry out extensive operations without any limitations
Customer Support
Customer support services available through phone and email provide convenient and reliable channels for addressing all concerns promptly.
User friendly Interface
The intuitive design and functionality of the UI screen allow for seamless navigation and efficient retrieval of eligibility data.
How E&E360 will benefit your Plan?
- Real time integration with CMS MarX for Medicare eligibility verification through webservice API.
- Multiple ways to verify data: Online (web site) or Batch (manual upload or automated upload).
- Validation rules built around CMS guidance, helps avoid plans from receiving avoidable rejects.
- Automated CMS transaction submission and management up to 3 times per day.
- Automated CMS response processing system receives and forwards all the CMS daily, weekly and monthly files.
- Submission and TRR reconciliation - Ability to query transactions at beneficiary level or plan level and match to TRR responses.
- Rollover processing services for Year-end CMS mandated rollover processing.
- BI Analytics reporting with CMS source files helps health plans to perform user self-service reporting.