Automated, Real-Time Verification of Member Enrollment and Eligibility
To stay competitive and compliant, healthcare payers must be able to quickly, accurately, and securely process electronic document interchange (EDI) files to verify plan members’ eligibility to receive coverage benefits. However, as payers’ IT legacy processing systems age, it becomes more difficult to turn around the required EDI 834 documents in a timely manner – especially in the case of identifying and fixing unprocessed exceptions that result in mistaken denial of benefits. Healthcare for members is delayed and creates a poor member experience, while payers face potentially hefty state and federal fines for noncompliance with mandated eligibility document processing timeframes.
Zyter meets the challenge with Zyter Enrollment Manager™, a solution that provides a real-time enrollment and eligibility processing platform along with a single, intuitive user dashboard – integrated out of the box with the payer system you already have.
Zyter Enrollment Manager™ streamlines and automates the enrollment lifecycle. Integrated with the payer’s IT processing system. Zyter’s highly-scalable API-based architecture significantly improves the processing of EDI 834 benefit eligibility files for member enrollment by enabling real-time verification of both completed files and exceptions right out of the box. Additionally, the highly secure Zyter platform ensures that Zyter Enrollment Manager meets all of the HIPAA standards required to support the secure electronic document interchange of all member enrollment documents.
Make Enrollment Processing Time More Efficient. Fix and Reprocess Exceptions Faster.
Zyter Enrollment Manager saves time and increases operational efficiency with robust features designed to modernize and transform the member enrollment and eligibility verification processes:
Support for High-Speed Processing – Zyter Enrollment Manager supports high-speed processing of multiple files simultaneously without degrading system performance. The Zyter solution enables the processing of 100,000 daily or monthly transactions in just 5 to 10 minutes. Thanks to Zyter’s seamless integration capability, processing on even older, homegrown legacy systems can be made more efficient.
Unprecedented Visibility and Tracking – Zyter’s intuitive user dashboard gives payers end-to-end, real-time visibility and tracking capability of all EDI 834 files – from input to output to the payer’s member database. Faster Identification and Reprocessing of Exceptions – Real-time visibility through the Zyter dashboard means that payers can catch and fix unprocessed exceptions or error files faster. The process to correct exceptions that used to take 48 hours, now can be completed in just 4 to 5 hours – and members can be approved more quickly for healthcare services and pharmacy services.
Assurance of State and Federal Compliance – In addition to meeting HIPAA requirements, Zyter’s support for high-speed processing and faster turnaround on reprocessing exceptions helps to reduce the payer’s risk of incurring multi-million dollar fines for EDI 834 processing time delays.
Improved Member Experience – With Zyter Enrollment Manager, payers can ensure a better member experience with faster, more reliable eligibility verification – no more mistaken denial of services that frustrate members and delay their care.
Modern Technology for Today and the Future
Transform member enrollment management and gain time and efficiency benefits with the following Zyter technical features:
Payer System Integration – Zyter Enrollment Manager integrates easily with major payer systems, such as QNXT, HealthEdge, Facets, EPIC and legacy mainframe systems.
Exception Workflow – Identifies exceptions in real-time and routes them to enrollment staff to correct them for reprocessing.
Rich User Experience (UX) Interface and Dashboards – Use the Zyter Dashboard to view transactions and process edits, as well as assign work, identify, fix, and reprocess exceptions or file failures, and perform other EDI management actions.
Support for Multiple Document Formats – Processes EDI 834 forms, plus transforms any other file format, including scanned or digitized forms.
Rules Engine for Expedited Enrollment – Validates files for fast, efficient processing to meet all state and federal timeframes.
Automated Workflows – Improve operational efficiency and productivity with automated scheduling, reminders, reports, and more.
Audits and Reports – Gain insight into your organization with transaction audit logs and customized reports.
Zyter Enrollment Manager Features
Built upon Zyter’s modern, cloud-based technology stack, these customizable features add up to a comprehensive solution for efficient EDI 834 file processing:
- Integration with major payer systems like QNXT, HealthRules, Facets, EPIC, and legacy mainframe environments
- Simplified 271 response
- Medicare rules mapping
- Management dashboards
- Real-time claims status management
- Authorization management
- 27X APIs
- Real-time eligibility service
- CORE compliance
- CMS SOAP call
- Digital signature security
- Intelligent collaboration
- Workflow automation
- Predictive analytics
Add Value to Your Member Enrollment Processes
Zyter Enrollment Manager benefits payer organizations in the following ways:
- Achieve higher operational efficiency with no delays in file processing
- Reduce costs with seamless integration of a cloud-based solution
- Save time with automated coordination of eligibility verification processes
- Ensure a better member experience by eliminating delays in eligibility processing and verification
- Ensure compliance with state and federal EDI 834 regulations
- Be ready for next-generation EDI platforms to stay competitive and responsive to members’ changing needs
