Policy Administration

Data Marshall manages all the aspects of policy administration.

As a standard part of new group installation, renewals, eligibility and enrollment processes, we prepare ID cards and written communication for employees and dependents. Changes, terminations, COBRA, plan re-instatement and run-in plan inclusions are all part of the broad array of services provided. Data Marshall addresses volume fluctuations with flexible staffing options that adjust to the needs of our client volumes during group installations and renewals as well as when a fluctuation in claim processing occurs.

Data Marshall has the expertise you need for Medicare and Medicaid groups. We manage open enrollments, special enrollments, retroactive disenrollment and claim processing services to meet the unique environment of Medicare and Medicaid.

Features

  • Perform new enrollment/group addition requests including the Run-in when adding mid-term.
  • Set up the Member eligibility record in system based on the group SPDs & the choices made by Member as per the Enrollment request.
  • Receive maintenance requests such as Dependent additions, terminations or reinstations and process within the TAT of 48Hrs.
  • Communication with groups for scheduled status verifications.
  • Assume the responsibility of Group renewals & periodical status verifications.
  • Determine COB & Verification of documents received in terms of COCC & FTS.

Approach

  • Assign group co-ordinators for each of the group to assume the accountability.
  • Balance the volume fluctuations with the help of cross-trained resources.
  • Track the calendar events by group, make schedules & plan the work assignments to ensure TAT.
  • Abstract the appropriate information from group SPDs & prepare quick reference sheets outlining group specific parameters.
  • Thorough verification of eligibility rules & substantiate with the information provided such as qualifying life events, COB & FTS status.

case studies

Enrolment Maintenance for a growing TPA located in Wisconsin.

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