Member Data Management

Payer Services

Medicare Member Management
& Enrollment Solutions

We deliver specialized Member Management and Enrollment Services tailored for U.S. Healthcare and Medicare Advantage organizations, ensuring full compliance with CMS regulations, operational efficiency, and an exceptional member experience.

Our solutions support health plans and TPAs in managing the complete member lifecycle — from enrollment to ongoing engagement — maintaining the highest standards of accuracy, timeliness, and regulatory adherence.

CMS Compliant
HIPAA Secure
Medicare Advantage
EDI 834 · MARx · BEQ · DTRR
End-to-End Lifecycle Management

Choose the Model That Fits You

Our Medicare member management services are built around flexibility, scalability, and operational excellence.

Model 01
Staffing Solution

Staffing-Only Model

Skilled professionals who integrate with your current systems to manage enrollment and member data efficiently.

  • Dedicated enrollment specialists
  • Integrates with your existing systems
  • CMS-trained, HIPAA-compliant team
Model 02
Technology Solution

Technology-Only Model

Our homegrown enrollment platform offered as a service, enabling automation, compliance, and real-time visibility.

  • Synthcare platform as a service
  • Real-time dashboards & reporting
  • EDI 834, MARx, BEQ automated
Recommended
Best of Both

Hybrid Model

A powerful combination of our platform and expert staffing, delivering a fully managed, high-performance enrollment solution.

  • Full platform + expert staffing
  • End-to-end managed service
  • Maximum scalability & accuracy
Core Capabilities

What We Do

Our team ensures every member interaction is handled promptly and professionally in accordance with CMS guidelines.

Eligibility Verification Accurate data validation and eligibility checks across all member records.
Member Enrollment Data Capture Paper, 834, and proprietary formats processed with precision.
Demographics & Plan Management Maintain member demographics, plan details, PCP assignments, and benefits.
Automated Report Generation ID cards, member/provider communications, and compliance reports auto-generated.
Real-Time Data Updates Ensure consistency across all systems with continuous synchronization.
Member Inquiry Handling Prompt resolution of claims, referrals, and PCP change requests.
Service Details

Deep Expertise Across Every Layer

01

CMS Compliance & Medicare Data Synchronization

Our operations are fully aligned with CMS requirements, ensuring compliance and audit readiness at every step.

  • MARx transaction processing — enrollment, disenrollment, and updates
  • Daily Transaction Reply Reports (DTRR) reconciliation and error resolution
  • Batch Eligibility Query (BEQ) handling
  • Synchronization of member records with CMS systems
  • Support for CMS audits and compliance reporting
02

Advanced File Exchange & Data Management

Seamless, secure, and compliant data exchange between health plans, CMS, and third-party systems.

  • Management of inbound and outbound EDI transactions
  • Integration with Synthcare by Synthesis HealthSoft
  • Continuous monitoring, reconciliation, and error handling
  • Data integrity checks to ensure accuracy and completeness
03

Flexible, Scalable & Cost-Effective Solutions

Our workflow model adapts to evolving client needs while maintaining high performance and cost efficiency.

  • Scalable operations to support business growth
  • Customizable workflows tailored to client requirements
  • Optimized processes to reduce operational costs
  • High-quality, consistent service delivery outcomes

Why Choose Us?

The expertise and infrastructure that sets Synthesis HealthSoft apart

Deep expertise in Medicare Advantage & CMS processes
Proven experience with EDI 834, MARx, BEQ & DTRR
Technology-enabled via Synthcare platform
CMS-Compliant Workflows & HIPAA Secure Data
99%+ Accuracy Rate with SLA-Driven Delivery
AEP Readiness & Scalability for peak periods
Customizable workflows aligned to your systems
3 service models — Staffing, Tech & Hybrid
Rapid onboarding & transition support

Connect with Synthesis

Ready to streamline your Medicare member management? Let’s discuss the right solution for your organization.

Get in Touch