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| Member
& Eligibility Management |
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| Our member's module allows your
organization to track all pertinent information about the member, their
entire eligibility history, claims and authorizations associated with
the member, provider assignments, as well as all dollars and
visits accumulated against their plan.
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Feature |
Benefits |
| Keeps a record of each member’s eligibility history |
Provides detailed data about a Member’s eligibility including their Membership IDs, Health Plans, Benefit Plans, Employers, Effective & Term Dates, if Coordination of Benefits Dollars should be expected, the priority of the coverage, and the reason for a change in coverage. |
| Captures valuable demographic information about Members |
Stores all pertinent information about the member including; age, sex, gender, prior names, nick names, SSN, Medicare ID, Medicaid ID, Addresses, Phone Numbers, Fax, email address, Language, Functional and Membership status, etc. |
| Allows grouping of Family Members |
Automatically tracks Family deductibles, copays and annual limits. |
| Tracks
history about provider assignments, authorizations, claims and
accumulated totals for Members and their families |
All claims and authorizations are stored for each member and can be viewed from the member module to assist with member services activities· Information is quickly accessible and easy to understand. This will save valuable time when you are researching member history.· All accumulated visit and dollar totals related to their benefit limitations can be viewed within the members module· Provider Assignments (PCPs) and change reasons are all tracked to assist your organization with quality assurance processes. |
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