TRR Enrollment to Fulfillment  

360E2F® is a business-configurable workflow solution for processing and tracking TRR enrollment to fulfillment.  MedHOK’s innovative web-based solution delivers greater accuracy and speed to membership enrollment and member/payment reconciliation processes. The result is dramatically reduced administrative costs, increased compliance and higher levels of member satisfaction through a user-configurable workflow solution.

Significantly minimize the time it takes to determine whether a member is eligible for enrollment applications through real-time eligibility membership checks. 360E2F® performs workflow validations and generates feedback on application completeness creating a reduction in errors in file accretion and resulting in significantly reduced rejections, which minimizes rework by staff. In addition, information is fully integrated and used to auto-populate enrollment screens, dramatically increasing efficiency. Downstream benefits include reduced enrollment-related discrepancies and more timely payments.

Key Features:

• Automation: System automates beneficiary eligibility confirmation with the CMS MARX system. Creates CMS transmissions and integrates electronically with CMS for batch and enrollment queries using Smart Connectors. System also automates the processing of the TRR and preparation of letters for members.
• Pre-enrollment/Campaign Management: System is configurable to accept all pre-enrollment functions by client.  Also capable of generating reports based on data received and stored in the database.
• Client On Boarding: System is designed for users to configure new clients without any support from IT staff.  This process reduces the time it takes to go to market significantly.
• Member Maintenance: Allows user to maintain all member contacts in a single system.  We are also capable of bidirectional data feeds.  Allows for real-time access to application status for member services.
• Exception Processing: System is able to handle exception (e.g., Out of Area) processing based on business rules and CMS requirements.
• Fulfillment: Application allows end user to configure event triggers that generate fulfillment documents to any print vendor.
• Rejection Processing: Able to push rejections through a predefined workflow process for correction and resubmission by the end users.  All work items are traceable and reportable as needed.
• Inventory Management: The system is designed to track and monitor all work items for adherence to TAT and SLA standards.  Full reporting is available for this area as well.
• Reconciliation Processing: Reconciliation processing  includes membership, TRR, retro and monthly reconciliations.
• Audit: System provides a full audit trail of any changes made in the system and stores who made changes, along with a date and time stamping item.  Also able to push work items to review queues for secondary review by QA/senior staff members for accuracy.
• Alerts: System is capable of sending/setting (text, email and member note) alerts when work items begin to age, work queues are larger than normal, etc.

Additional Features:

• Full reporting capabilities to generate both canned and ad-hoc reports.
• Able to handle phone, fax, paper, and EDI application submission and transmit TRR data to and from CMS.
• Can easily accommodate rapid Medicare membership growth without building large infrastructures utilizing cloud technologies.
• Minimizes the need to commit highly skilled personnel to comply with CMS data submission requirements and system.
• Enhances cash flow and captures lost revenue through more accurate and timely enrollment processing and reconciliation.
• Maintains full control of workflow, automated logic and reporting functions at the end user level.
• Stays ahead of enrollment trends affecting administrative, financial arenas through comprehensive data warehousing and reporting capabilities.