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Our Medicare Advantage experience includes:
System Development and Design Services
- Business Assessment from Business User and Technical perspective
- Creation of Functional and Technical Specifications
- Creation of Business User Work Flows
- Creation of System Work Flows
- Creation of Entity Relation Diagrams
- Development/Enhancement of Enrollment functions to meet CMS requirements
- Development/Enhancement of System Audit capabilities to meet CMS requirements
- Development/Enhancement to perform Member Reconciliation
- Enhancements to accommodate the Encounter requirements for RAPS
- Enhancements to capture incoming TR Code and update Member records with CMS Status (accepted or rejected)
- Enhancements to update processing systems based on TR Code, such as date of death, different county code, institutionalized, disabled, ESRD, hospice, Medicaid on/off, and Medicare Part A/B on/off
CMS Correspondence Requirements
- The use of Crystal Reports and stored procedures to automate the CMS Model Letters based on TR Codes
- Enhancements to capture when COB, HOS, and Working Aged Surveys are sent, received, and responses processed
- Capturing begin and end dates for grievances and appeals
Importing Data from CMS / Exporting Data to CMS
- System enhancements to accept the following CMS data files:
- Batch Eligibility Query Response File
- Batch Completion Summary Status File
- 4RX Notification Response File
- TR (Weekly and Monthly)
- MMR
- Risk Adjustment Model Output
- Download of all CMS Monthly Data Files
- System enhancements to export the following CMS data files:
- Daily Enrollment Transactions
- Batch Eligibility Query
- 4RX Notification File
- RAPS Files to Palmetto
Medicare Advantage Implementation Services
- Business Needs and Assessment
- System Enhancements
- Testing of System Enhancements
- Creation of Work Flows
- Creation of Policies and Procedures
- Creation of User Documentation
- Testing of importing and exporting of CMS Files
- Research and analysis of System updates resulting from TR and MMR data files
- Generation of Correspondence
- Preparation for RAPS process
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