How to Maintain the Accuracy & Consistency of Data through an Entire Life Cycle

January 22, 2015
|In Performance Optimization, Brain Food
|By GHG Advisors

It doesn’t matter whether you call it the Annual Election Period (AEP), Open Enrollment Period or Fall Open Enrollment; it’s that busy time of the year when beneficiaries are on the move. Now that the dust has settled, it’s time to take a thorough look at your member data. Your members are your revenue. Accurate member data and continuous maintenance will yield the maximum, most accurate level of revenue to your organization.

While Plans strive to have correct data in their systems right from the start, it doesn’t always work out that way. The result is inconsistencies in data and the need for an “AEP Reconciliation“. That’s the process of identifying a discrepancy, correcting it and not only making it right, but keeping it right. Reconciliation is about maintaining and assuring the accuracy and consistency of data from the start and over its entire life cycle.

Member data is the heart of an organization and the driver for many processes. It’s critically important that this data is correct in all of your organization’s systems. All systems need to be in sync, CMS to Plan, Plan system to Plan system, Plan system to PBM — it’s a continuous circle of checks and balances.

Accurate data not only helps create that important first contact experience with your member but keeps you connected to your member. Correct member data reinforces your organizations credibility and promotes a feeling of value to your member.

Data Reconciliation Tips

  • Member Demographic Information — Maintain and update any changes to names, DOB, addresses (permanent, billing, personal representatives, POA’s), telephone numbers, email addresses.
  • Enrollment Spans— Verify that the Plan/PBP/LIS is correct in all spans within the enrollment — not just the current span.
  • Payment Method — Validate that the correct payment method is set up (SSA, Direct, RRB, EFT, etc.)
  • Special Status — Update special status or status flags in the appropriate systems to ensure proper claims payment and plan payment. (i.e. ESRD, Hospice, MSP, Medicaid, Institutional etc.)
  • Optional Supplemental Benefits — If your enrollee elects supplemental benefits, verify the Part C premium change was submitted to CMS.
  • CMS Reports — Work monthly CMS reports promptly and completely. (List of CMS reports is available in PCUG v8.3, Table K-1 All Transmissions Overview)
  • Plan Discrepancy Reports — Compare data within your own plan systems and with your PBM. Create discrepancy reports and work them daily or weekly.

Don’t forget about Medicare Secondary Payer (MSP) Reconciliation!
Now is the best time to tackle all that MSP information you’ve received. Many plans get overwhelmed with MSP data, especially at this time of the year, and find it difficult to perform the time consuming outreach and research that’s necessary to obtain validation results.

This simple process carries a powerful financial punch — efforts here can yield big results! GHG can assist with MSP Reconciliation. We have experienced analysts that can research, perform outreach and reconcile your MSP data.

Start the year off right – with clean, accurate data.
GHG’s Consultants and Reconciliation Analysts have the expertise, knowledge and experience for all your reconciliation projects.

 
Resources

To hear more information on reconciliation, including detailed evaluations of the MMR & MOR reports, come hear GHG’s expert, Jennifer Young explain the Fundamental of Membership Accounting & Reconciliation, January 26-27th at the Medicare Advantage Membership Accounting & Reconciliation Conference, Sanibel Harbour Marriott Resort & Spa, Ft. Myers, FL.

Let GHG check the box in each and every operational area of your organization. Our team of veteran experts can assist in AEP preparation, transmitting of timely and accurate membership information, recommending staff levels and utilization, and maintaining and improving all enrollment processes. Visit our website to learn more >>

Registration for the Gorman Health Group 2015 Forum is now open. Join us April 7-9, 2015 at the Gaylord National Resort and Convention Center in National Harbor. Register today >>