METTS

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  • Built specifically for the MA-PD market
  • Designed and built by industry leading experts proficient in processing, auditing, consulting, and client installations. 
  • Flexible Technology
    • Rules based enabling CMS compliancy
    • Client configurable facilitating special needs
    • Reliable standard CMS file feeds and client feeds
    • Scalable ensuring capacity to grow
    • Audit and controls hard-wired into the system  
  • BPO interfaces
    • Secured / scalable internet access for online enrollment management
    • Mail file creation and tracking
    • Operational reporting, including dashboards built into the system

Enrollment / Eligibility

  • Support electronic and on-screen entry of apps
  • Perform BEQ/RFI checks
  • Rule-based Daily TRR Files processing& Reporting
  • BEQ Reports
  • Error Reports
  • Involuntary Disenrollment Report
  • Track audit of changes
  • Track 4rx changes
  • Track statuses
  • Tracks Plan/PBP changes

Authorized Representatives

  • Capture Authorized Rep data
  • Enforce authorized rep rules

Customer Service

  • Track Inbound/Outbound calls
  • Capture comments and Action Items from calls
  • Report on call frequency, call trends and other items
  • Capture history of call logs

Broker/Sales Commissions

  • Track Broker Sales
  • Apply CMS Initial and Renewal Sales Rules
  • Enforce CMS Rapid Disenrollment chargebacks
  • Reconcile with Broker Compensation Report
  • Apply Retroactive Enrolls/Disnerolls

Demographics Tracking

  • Tracks Changes  to Demographics fields
  • Allow date-based changes

Member Communications

  • Manual and automated correspondence generation
  • Multi-Language Support
  • Letter Files
    • RFI
    • ID Cards
    • TRR
    • Event-based letter generation
    • LEP
    • COB Survey

Roles & Accessibility

  • Only show items that pertain to User role
  • Enforce read-only vs Full-functionality based on roles

PCP Tracking & Capitation

  • Track PCP Choices and enforce 1st of Month Rule
  • Calculate Capitation for Risk-bearing entities

Late Enrollment Penalty (LEP)

  • LEP Administration
  • LEP Reporting

OEV & OOA Workflows

  • Track OEV items
  • Manage OOA cases

Compliance and Audit

  • Track Compliance measures
  • Use Workflow Queues to kick out items that don’t conform
  • Real-time compliance monitoring

COB Administration

  • Other Health Insurance (OHI) file to support COB
  • MARx COB Reporting
  • ECRS Submissions

Workflow

  • Place pertinent items to work-queues
  • Manage Workflow assignments
  • Track queue items life-cycle