Member Management
Our member enrollment services reduce the administrative burden and cost to support member enrollment processes. Our eligibility and benefits configuration, backed by our knowledge-based platform, addresses the recurring industry problems with inaccurate benefits configuration. Utilizing this leads to a reduction in improper claim payments and a decrease in appeals and grievances.
ELSOFT Technologies manages the eligibility and enrollment process for our clients, including the verification and determination of each member's coverage to help automate the process and free up necessary resources.
ELSOFT Technologies ' skilled team of subject matter experts manages the eligibility and enrollment process for our clients, including the verification and determination of each member's coverage specificity. Delegating this task to ELSOFT Technologies allows your organization to free up resources and concentrate on core business functions that optimize internal operations.
Our eligibility and enrollment solutions handle
- Switching over plans from the previous year and initiating the coverage under new plans
- Ensuring the correct PPO coverage is linked to each member in the case of commercial payers for small groups
- Making sure the defined stop loss coverages are linked to correct groups
- Capturing and checking the patient information against the eligibility database