Revenue360 Supported Feature

Medicare Advantage (MA)


Intelligent Automation

  • Captures various Part C and Part D payments and includes member premium for SSA withholding.
  • Automatically applies lump sum retroactive payments split across months.
  • Calculates the plan’s expected monthly payments.
  • Uses a unique reimbursement model.
  • Typically makes payments to providers for Medicaid beneficiaries on a fee-for-service basis.
  • Facilitates reimbursement based on a predetermined fee schedule or negotiated rates.
  • Uses the 834 file format to integrate with Medicaid systems and perform required reconciliation.

Actual Vs Anticipated payments


  • Resolves discrepancies between payments received by MA plans and calculated amounts based on risk adjustment and other factors.
  • Helps finance department get an accurate picture of money owed to or from CMS.
  • Helps finance department get an accurate picture of money owed to or from states.

Automated processing of Inbound files

  • Enables automated processing of files directly from CMS or passed along from the customer, as well plan membership files from different sources.
  • Manages data from both paper and electronic provider submissions for reimbursementent.


Flexible Reconciliation Frequency

  • Enables MA plans to process files within monthly reconciliation timeframe or as per health plan requirements.
  • Accommodates weekly, biweekly, or custom frequencies

Discrepancies identification and resolution

  • Integrates with member management systems to identify member- and contract-level issues.
  • Assists plans in understanding how discrepancies impact payments, and offers resolutions or otherwise acts on discrepancies.

Reporting & Oversight

  • Supports CMS compliance requirements including financial reporting and audits.
  • Provides state-specific reports including financial reporting, program integrity, and audits.

Meets Regulatory Compliance requirements

  • Maintains compliance with CMS 45-day attestation requirement.
  • Helps identify demographic and financial differences between plan and CMS data.
  • Implements according to the unique regulations, reporting requirements, and date submission guidelines of each state's Medicaid program. 

Standard Reports

  • Automatically generates more than 40 monthly reports and data extracts to help plans monitor trends and understand discrepancies, including reports on payment summary, balance brought forward, discrepancy aging, and suspense amount.
  • Provides add-on recon analytics powered by a BI   tool for data visualization and ad-hoc analysis and reporting by the end users.

User Friendly web portal

  • Provides simple, intuitive navigation to research and analyze discrepancies, keep close track of open discrepancies for resolution, and maintain an audit trail of actions taken to resolve discrepancies.

Medicare Part D Reconciliation

  • Enables manually entry of direct and indirect remuneration (DIR) into PDE annual reconciliation tool.
  • Tracks online total CMS paid versus estimated low-income cost sharing, reinsurance, risk, and coverage gap payments.
  • Not Applicable

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