Member Data Management

Payer Services

Medicare Member Management & Enrollment Services

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 Services 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
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 0199%Accuracy
Operations Solution

Operations-Driven Model

Our team manages the agreed claims operations and ensures quality, productivity, and timely service delivery.

  • End-to-end claims processing
  • Dedicated claims and quality teams
  • SLA and TAT management
  • Denial, rework, and underpayment handling
  • Regular performance reporting
Recommended
Hybrid Solution

Hybrid Model

A flexible model that combines dedicated claims staff with managed operations support.

  • Dedicated claims processing team
  • Flexible staffing based on claim volumes
  • Claims processing and management support
  • Shared operational responsibilities
  • Quality and compliance monitoring

What We Do

Our experienced team provides accurate and timely Medicare member enrollment support in line with CMS requirements.

Enrollment & Eligibility VerificationVerify member eligibility and enrollment information for accurate processing.
Enrollment Data ProcessingProcess and validate Medicare enrollment data accurately and efficiently.
Member Demographics & Plan InformationMaintain accurate member demographics, plan, coverage, and PCP information.
Member MaintenanceProcess member updates, changes, and disenrollment requests accurately.
Enrollment Quality & CompliancePerform quality checks and ensure enrollment activities follow CMS and client requirements.
Member Inquiry SupportHandle enrollment and eligibility inquiries and support timely issue resolution.
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
  • Member Data Maintenance – Maintain accurate and up-to-date Medicare member records.
  • 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
  • Error Identification & Resolution – Investigate and resolve enrollment data errors and exceptions.
  • Continuous monitoring, reconciliation, and error handling
  • Data integrity checks to ensure accuracy and completeness
03

Flexible, Scalable & Cost-Effective Services

Our Medicare enrollment services can scale with changing business needs while maintaining accuracy, quality, and timely processing.

  • Scalable operations to support business growth
  • Client-Specific Processes 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
CMS-Compliant Workflows & HIPAA Secure Data
99%+ Accuracy Rate with SLA-Driven Delivery
AEP Readiness & Scalability for peak periods
Flexible Workflows Aligned to Client Requirements
3 Service Models — Staffing, Operations & Hybrid
Rapid Onboarding & Service Readiness

Connect with Synthesis

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

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