Enrollment and Eligibility

StrategicHealthSolutions, LLC (Strategic) provides enrollment and eligibility services for a variety of government programs. Enrollment application screening is performed to verify compliance with enrollment standards, determine whether the information is sufficient, and process initial enrollments as well as change of information applications. All application screenings are performed according to the instructions of the Medicare Program Integrity Manual.

Strategic has solid experience analyzing Medicare beneficiary enrollment and eligibility information and has the ability to manage high-volume review workloads in keeping with mandated time frames.

Services

  • Determine whether the information is sufficient and complete
  • Ensure compliance with enrollment and eligibility standards
  • Detect contradictions with other information
  • Process enrollment applications
  • Validate provider information
  • Perform pre-screening activities
  • Maintain quality scoring
  • Detect contradictions and vulnerabilities
  • Adhere to Health Insurance Portability and Accountability Act (HIPAA) and privacy standards
  • Determine whether the information is sufficient and complete to warrant payment

The Strategic Advantage

  • Process-oriented approach with measurable results
  • Staff skill level moderates recruitment and rates
  • Scalable process adaptable to other programs
  • Identification of trends, aberrancies, and program vulnerabilites
  • User-defined reporting and standardized reporting
  • Support Standard Operating Procedure (SOP) development