Enrollment Management

For many health plans, member enrollment remains a fragmented process made up of a patchwork of siloed vendor and homegrown systems. A lack of seamless integration and inconsistent data standards across all lines of business can negatively impact members at the very moment they attempt to use their benefits such as incorrect eligibility determinations.

Discover more in Interoperability

Transform enrollment operation with intelligent automation that identifies and resolves data inconsistencies before they impact members, providers, and systems of record.

Configurable business rules, validations, enrichments, and auto-corrections help reduce manual effort and accelerate issue resolution, while upstream data scrubbing and reconciliation capabilities protect membership data integrity and minimize enrollment fallout. Authorized users can manage member updates and exceptions directly within enrollment workflows, improving operational efficiency, governance, and auditability without relying on core administration systems for routine corrections.

Cotiviti Enrollment Management by the numbers

Enrollment Management solution benefits

• Improve Enrollment Accuracy and Data Integrity – proactively detect, validate, and reconcile enrollment data to prevent eligibility errors, payment discrepancies, and downstream claims issues before they impact members or operations
• Reduce Administrative Costs Through Intelligent Automation – automate validations, reconciliation, exception handling, and issue resolution workflows to minimize manual effort, accelerate processing, and improve operational efficiency
• Strengthen Compliance Across Complex Regulatory Programs – support evolving Commercial, Exchange, Medicare, and Medicaid requirements with auditable workflows, controlled governance, configurable business rules, and comprehensive transaction oversight
• Empower Business Users with Operational Self-Service – enable internal teams and external partners to onboard, maintain, correct, and monitor enrollment activity through role-based access, configurable workflows, and end-to-end visibility
• Scale and Integrate Across the Enrollment Ecosystem – connect seamlessly with existing enrollment, membership, and partner systems using flexible integration frameworks, broad format support, reusable configuration models, and implementation accelerators