Part D Enrollment Reconcilation
Today’s enrollment department is properly described as a revenue management center, whose performance establishes the overall direction of your plan towards success or failure.
Recent guidance from CMS dramatically limiting the timeframes for retroactive enrollment reconciliation--and changing the rules for doing so--have also compounded the difficulties for accurately managing your membership.
In order to meet these needs, Gorman Health Group has enhanced its consulting resources to include software and off-site analytic services to give you a full range of solutions. Our teams will diagnose, “clean up” and enhance your enrollment department with an eye to enhancing your ability to establish and maintain a virtuous health membership life cycle.
In a typical engagement, we will use Valencia, our proprietary membership reconciliation software to quantify the extent of your needs. Our software increases the efficiency and productivity of reconciliation efforts: it helps cut down on working "false positive" cases while reducing the amount of time required to reconcile each member.
For plans that have identified break-downs in underlying processes, our senior consultants rebuild that processes the support descrepency identification, workflow controls and inventory management. Where appropriate, we assist your plan by selecting and implementing additional tools that prevent errors from happening in the first place.
Whether as a natural next step after supporting a Reconciliation effort, or as a stand-alone engagement, GHG has an outstanding mix of experienced IT, Operations, and Regulatory Management personnel to provide a health plan with a range of options, from diagnosis to tune-up to overhaul of the complex, temperamental and interdependent business unit on which all other plan functions depend.
