Smart enrollment: how AI is transforming Medicare Advantage

When Medicare Advantage (MA) enrollment lags, health plans put their success at risk. Undergoing enrollment season with manual-heavy tasks often forces payers to apply band-aid solutions to get through the season and prepare for the next year – insufficient solutions like adding temporary staff or patching technology systems to comply with annual CMS regulatory changes.

Streamlined member enrollment is foundational to health plan success. It helps to increase staff efficiency and ensure member satisfaction. Highly accurate data from enrollment also drives value across sales, claims, risk quality, and compliance.  

However, the inability to track the full member lifecycle due to disparate data sources hinders centralized, real-time visibility. Meanwhile, downstream challenges in submitting enrollment data make effective member management nearly impossible.

Fortunately, technology powered by artificial intelligence (AI) has helped health plans transformed MA enrollment season. Automating critical processes, streamlining communications, and ensuring compliance and data integrity, AI-powered technology is changing the way MA plans conduct enrollment, benefiting everyone.

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Harnessing technology for a better enrollment season

To make MA enrollment smarter, payers need innovative, AI-powered technology that can provide the critical automation, compliance, and data integrity necessary for success. Essential components of this technology should include:

• Real-time Medicare eligibility verification.
• Automated application and data submission to CMS.
• Pre-built workflow management tools to track compliance.
• Member correspondence automation to improve communication.
• Complete data transparency within the user interface.

The automation offered by advanced member management technology is quickly becoming a necessity for successful health plans. "In the past, we had zero automation” said one Senior Operations Manager at a regional health plan. “Our analysts and coordinators had to look at the system, update the member, make sure they match, and then create a letter manually. Everything was manual. We wouldn’t make it today if we were still doing those things."

Automating member management with AI-powered technology can help plans work more efficiently and ensure compliance, boost data integrity, and improve the member experience. The result? Increased value across health plan operations and a significant return on investment.  

What smart MA enrollment looks like

Smarter, faster, better with automation

Smart MA enrollment is fast, effective, and minimizes manual tasks for staff. Health plans using AI-powered member management technology are able to automate previously time-consuming components of the enrollment process including member eligibility verification, maintenance, enrollment, and election submissions to CMS. Technology can also handle data hygiene tasks, saving significant staff time on data management.  

Ensuring compliance and reducing risk

Keeping up with regulatory changes on an annual basis by using band-aid solutions like temporary staff and system patches not only requires significant staff time – it increases the risk of non-compliance. Non-compliant health plans are on the hook for a range of financial penalties and may be putting their MA contract on the line.  

Smart MA enrollment not only entails advance planning to ensure compliance with CMS. It uses AI-powered technology that is purpose-built for CMS. Technology with seamless CMS integration makes managing compliance simple, while full audit transparency within the user interface enables accountability and tracking.  

Navigating regulatory compliance is complex, and successful MA enrollment requires the right technology infrastructure to adapt to both state and CMS regulatory changes in real time.

Increasing the reliability of your data

A centralized source of accurate data is critical to the entire scope of health plan operations, facilitating smarter decision-making in the areas of finance, quality, and operations. But plans need an accurate, real-time view of member data at any moment in their lifecycle to make it possible.

AI-powered technology enables access to accurate data in real time. By providing an end-to-end picture of member data, from enrollment through reimbursement submissions, this technology supports reconciliation layers between multiple solutions from inception through reimbursement submissions. It also removes manual false interpretations for decision-making scenarios like enrollment election rejections and exceptions.

Transparency in a members’ data lifecycle can also fuel Star Ratings, impacting the possibility of revenue through CMS bonuses and the ability to attract new members. By introducing a high level of data integrity into the enrollment cycle, health plans can lay the foundation for success in all areas of their work.

Member-centric enrollment

Member satisfaction with health plans has declined in recent years. In 2023, it dropped by 13 points, and a significant part of that was due to concerns with customer service and inadequate communication. Smart MA enrollment automates key workflows to make the entire process fast and easy for both members and health plan staff.

Automatic generation of member correspondence, attached to the member record, ensures timely and accurate communication to members. Additionally, automated enrollment and disenrollment make it the processes quick for members, and member-initiated disenrollment empowers consumers with the control they’re looking for when it comes to managing their health insurance.

Unlocking the full value of AI-powered enrollment

MA plans need smart member management technology powered by AI to lay the foundation for success in value-based care. When they streamline enrollment, the benefits have a ripple effect across the entirety of health plan operations. MA plans can save significant staff time, reduce the risk of non-compliance, better inform decision-making with accurate, real-time data, and improve the member experience.  

Leveraging AI-powered member management technology for enrollment leads to a smart and successful enrollment season – and carries benefits across plan operations. Schedule a demo of Reveleer’s Member Management software to experience how AI-powered enrollment technology can lay the foundation for MA plan success.  

“With Reveleer, there’s so much automation set up that when revenue reconciliation hits, we’re ready. We don’t have to wait for anything. We can go right to it and see everything we need in one place and in real time,” said the health plan manager.