Regulatory Headwinds: CMS Compliance and Oversight
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Smarter, Faster Medicare Advantage Member Acquisition & Enrollment Technology
Powered by automation, seamless CMS communication, and an unrivaled member experience.
Talk To UsU.S. Owned & Operated Since 2006
Established alongside Medicare Advantage (MA), we’ve harnessed big data, predictive analytics, and our proprietary algorithms to fuel compliant membership growth for start-ups, regional, provider-owned, university-affiliated, national insurers and TPAs.
Our deep expertise and exclusive focus on MA allow us to outpace global competitors and serve as a dedicated partner in achieving our client’s strategic vision.
Frictionless Member Lifecycle
First impressions matter. A seamless enrollment process is fundamental to member satisfaction, financial stability, regulatory compliance, and competitive advantage.
MedicareCRM®
ECM™
EMMA™
Automated.
Intelligent.
Compliant.
Secure.
Manage all communications with CMS through the most advanced features and frequent enhancements that integrate new regulatory requirements.
Enrollment Processing
- Application intake from any source
- Automated, real-time completeness checks
- Real-time eligibility determination
- Enrollment to CMS confirmation within 24 hours
Accretion & Reconciliation
- Cavulus or plan acting as CMS submitter
- MBIT creation for CMS submission
- Complete TRR processing with automation > 90%
- MA/MAPD/PDP/Group/SNP workflows
Performance Optimization
- Intelligent, rules-based enrollment
- Exceptions sorted into logical queues
- Automated CMS letter generation
- Streamlined UI with easy access to data
CMS Compliance
- CMS timelines enforcement
- Monthly reconciliation CMS data vs. EMMA
- Model and non-model member correspondence
- Automated complex calculations (eligibility, LEP, etc.)
Change is inevitable. Leverage out-of-the-box best practices along with uncommon flexibility for unique business rules, TPA arrangements, and an evolving regulatory environment.
Cavulus Benefits
Exclusive focus on Medicare Advantage.
Built-In CMS Compliant Workflows.
Cavulus support included 24x7x365.
Vertically integrated, completely U.S.-based employee model.
No seat-licensing or per-user costs.
Leverage deep payor expertise and national insights.
