Medicare Advantage 360 Platform

Medicare Advantage Payors need to increase efficiency while maintaining compliance. At Wipro, we help achieve this through our industry-leading SaaS-based Medicare 360 solution and services that are founded on a state-of-the-art Medicare Advantage, Web-based technology platform as well as our global, Business Process Outsourcing service delivery model.

How Wipro Helps

Through our Medicare Advantage 360 (Duals) platform we offer:

  • Compliance with Centre for Medicare and Medicaid services mandates, increased operational efficiency with member, revenue and Data Management Services
  • CAPEX-light model: Technology solution is offered on a cloud-based model, hosted on our HIPAA-compliant, secure data center
  • Seamless integration and handling of Medicare Advantage Disenrollment Period: Prescription Drugs Plans and Dual-Eligible (MMP) population
  • Real-time eligibility checks though Centers for Medicare & Medicaid Services-provided Member Beneficiary Database extract

With more than 24 years of being a Center for Medicare and Medicaid Services (CMS) contractor for Medicare Beneficiary Data (MBD), our cloud-based Medicare Advantage platform is used by 90-plus Medicare Managed Care Organizations (MMCOs), comprising over 450 separate health plans. It touches more than 10 million Medicare lives today.

Our flexible, integrated platform provides real-time eligibility and enrollment, financial reconciliation, member management and encounter data services to Medicare Advantage and Prescription Drug Plans, on a per-member per-month model, easy-to-use software, compliant with CMS requirements.

Key Benefits:

  • First-pass rate to CMS greater than 97% , with greater than 99% rate of enrollment acceptance by CMS
  • Automation of 90% of CMS correspondence through rules-based triggers in workflows
  • Transaction Reply Codes tracked and reconciled at the member level with automated workflow triggers to each respective TRC
  • 200-plus member level edits
  • Auto-population of enrollment application fields enable an average time of less than 2 minutes per enrollment to process
  • Automated sync with CMS member and financial data for reconciliation and attestation requirements
  • Early warning signals identify financial mismatches and potential loss of revenue
  • Automatic updates to financial systems with payment extracts and customized G/L feeds
  • Part D annual reconciliation and forecasting
  • 100% accuracy and compliance of encounter data submission to CMS

Wipro is also the exclusive Duals partner with CMS and Mathematica for MMP CMS submissions and processing. We currently have 5 MMP Dual states in production - California, Massachusetts, Illinois, Virginia and Ohio.