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Enrollment Resolution & Reconciliation (ER&R) Form
Automation
Client Objectives
• The health plan submits ER&R (Enrollment
Resolution & Reconciliation) form to CMS to
resolve any disputes in enrollment data
between the issuer and CMS.
• Client was struggling with several errors in the
ER&R forms submitted to CMS, especially in
the formatting, which significantly impacted
CMS acceptance percentage.
• Caused extensive payment delays from CMS to
the payer and resulted in significant manual
rework.
Firstsource Solution
• Firstsource process excellence experts
studied the samples to understand the area
of failure
• Identified the root causes of formatting
issues which were due to manual
consolidation done by the supervisors post
receiving inputs from the examiners
• Built ER&R application which was integrated
with the TM (inventory) tool
• The tool was equipped with logic pertaining
to each submission category and an auto
consolidation feature which completely
eradicated the manual intervention that was
causing an incorrect submission
Business Outcomes
• 100% of the ER&R volume processed using
the automation tool
• Improvement in CMS acceptance rate from
39% to 99% within two months
• Reduced rework
• Quick resolution of CMS disputes and
release of pending payments to the client
A Fortune 500 company that
provides managed health care
services under the Medicaid
and Medicare programs
100%
ER&R volume processed using
automation tool
$