Membership & Financial Data Reconciliation
Synchronize Data, Maximize Revenue
Optimize your management and reconciliation of Medicare membership and Health Insurance Exchange financial data.
In the complex landscape of healthcare, reconciling Medicare member data and Health Insurance Exchange payments can be a daunting task. Manual processes, data discrepancies, and ever-changing regulations can strain resources and impact your bottom line.
Streamline and automate workflows, improve accuracy, and reduce the risk of financial errors allowing
you to focus on what matters most–delivering exceptional care to your members.
Medicare member reconciliation
Gain full visibility into your membership and premium-related data discrepancies.
Simplify Medicare member reconciliation, ensuring accurate payment processing and minimizing discrepancies. Our advanced technology automates key processes for revealing clean member data, including:
Data reconciliation and validation
Identify and rectify discrepancies between CMS and your plan for correct member records.
Retroactive processing
Manage retroactive adjustments for accurate and timely payment reconciliation each month the member is enrolled.
Discrepancy resolution
Identify and resolve discrepancies to minimize revenue leakage and maximize financial performance.
Membership reconciliation
Enrollment data validation
Transaction Reply Report (TRR) validation
Out of Area (OOA) tracking
Medicare Secondary Payer (MSP)
Coordination of Benefits (COB)
Prescription Drug Event (PDE) case identification
Payment reconciliation for the Health Insurance Exchange
Eliminate missed revenue opportunities and prevent inappropriate claims payments
Streamline payment reconciliation for Exchange plans for accurate financial management and compliance with regulatory requirements.
Our solution supports Issuers in:
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Enrollment data reconciliation
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Enrollment data dispute generation
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Enrollment data dispute response processing
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Plan payment report (PPR) reconciliation (PPR / 820 reconciliation)
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PPR / 820 dispute generation
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PPR / 820 dispute response processing
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Financial reporting
Miramar:Reveal has been managing enrollment and payment data since 2007.
Join the ranks of payers and issuers leveraging a dedicated, standalone reconciliation technology to better manage regulatory requirements and increase visibility into how data flows through the organization.
Have questions or need assistance?
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