MedAdvantage360
Wipro’s Member360 is a fully automated CMS compliant Member
Management and Premium Billing management System.
Member360 focuses on providing membership enrollment and
management, supported by correspondence automation and
generation, TRR, CMS file reconciliation and premium billing.
Amongst other features as represented in the diagram below, one
of another key highlights of the product is to provide a 99%
first-pass acceptance rate, leading to lesser number of
rejections from CMS, with improved star ratings.
99% first-pass acceptance rate leading to lesser rejection from CMS
Member360 Key Components
Enhanced UI + Mobile Support
Out of box Dashboard Tool
Rapid Data Entry
Bot Automation
Inbuilt Productivity
Tools
Modernization of a leading BCBS Health Plan
Wipro implemented end-to-end BPaaS platform with Enrollment, Membership, Agent commissions and Encounters.
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Leading Medicare Advantage Start-up Plan Implementation
Wipro helped achieve growth objectives and addressed the pressing business needs for a Medicare Advantage
Health Plan.
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Automated Medicare Eligibility Verification
A member’s Medicare eligibility is verified using the Centers for Medicare and Medicaid (CMS) Medicare Beneficiary Database (MBD) as applications are entered either by batch or online. During the verification process, CMS member-specific data such as ESRD, Medicare eligibility dates, LIS, and LIC are automatically added to Member360.
Membership Enrollment
Wipro's solution produces high acceptance rates by validating enrollment transactions for eligibility, format, and avoidable reject errors prior to submission to CMS.
Membership Management
Member360 maintains a complete history of member activity including: eligibility, CMS transactions, correspondence, and billing transactions. Standard work queues allow enrollment, finance, and customer service staff to efficiently research issues and answer questions related to an individual member or a group of members.
CMS Correspondence
Member360 allows for correspondence management through both automatic and manual processes. CMS Model Letters for MA, MAPD or PDP can be created in English and Spanish, and can be customized to include logos, plan IDs, signatures and special footers.
How will Member360 benefit your Plan?
- Reduces entry time by auto-loading demographic fields from the TRR and MMR
- Provides a workflow for rejected members creating an easy-to-manage membership
- Provides TRC escalation reports
- Automatically triggers letters based on member workflow status and TRC codes received from the TRR
- Increases enrollment first-pass rate and adds key information not found on the application by performing up-front eligibility verification
- Produces the Acumen file automatically
- Adjusts invoice amounts for LIS/LEP automatically based on CMS rules
- Reduces member complaints
- Keeps your organization current with CMS requirements at no additional cost
- Provides more benefits for less money; no hardware to purchase, no software licenses and no costly on-site installations
- Can be configured to comply with requirements for Dual programs