Proprietary AI and deep CMS expertise bring efficiency, compliance readiness, and payment accuracy to Medicare Advantage plans.
Reveleer, a leading healthcare technology workflow, data, and analytics company committed to driving sustainable value-based care for health plans and risk-bearing providers, today announced enhancements to its Member Management suite allowing health plans to reconcile retrospective adjustments to CMS payments for member care.
Reveleer Revenue Reconciliation provides greater transparency into revenue by tracking discrepancies between what a plan expected CMS to pay for member care and the amount paid – and how payments are adjusted through the year. With the latest enhancements, health plan finance teams can track retroactive payment adjustments at the member level in real time and flag likely prospective adjustments.
Designed and consistently maintained to comply with ever-changing CMS requirements, regulations, and rules, Reveleer’s Member Management suite is a cloud-based solution that integrates Member Enrollment, Premium Billing, and Revenue Reconciliation processes, powering them with real-time member data as the sole source of truth across the system.
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The solution brings efficiency and accuracy to member management operations by automating and streamlining workflows across eligibility verification, member communication, invoice generation, and payment reconciliation.
“Value-based care leaders understand how complex enrollment, billing, and reconciliation is due to ongoing CMS changes and the frequency of member reimbursement adjustments made throughout the year,” said Jay Ackerman, CEO and President of Reveleer. “These enhancements, along with proprietary AI and deep CMS expertise, enable Reveleer to provide a complete Member Management solution that improves speed, accuracy, and compliance from enrollment through payment attestation.”
As part of the Member Management suite, Reveleer Member Enrollment drives efficiency and accuracy by automating workflows across member touchpoints, including member correspondence and real-time enrollment status tracking. Reveleer Premium Billing simplifies Medicare Advantage and Part D billing and dues invoicing processes to calculate premiums accurately.
SOURCE: PRNewswire