Madena’s Synchronicity™ reconciliation software suite results from decades of industry experience understanding and interpreting CMS & state data files. Our comprehensive algorithms compare your system data to government files and identify discrepancies where many other systems may fall short.
We offer a comprehensive integrated suite, or individual modules based on your current system infrastructure. Synchronicity™ can support all Medicare and Prescription Drug plans.
Monthly Membership Reporting (MMR) Reconciliation
Accurate membership for your organization is our goal. We have extensive experience building systems for the Retro Processing Contractor (RPC) and Medicare health plans. Our algorithms accurately identify enrollment, demographic, plan and status discrepancies.
We encourage health plans to migrate historical data to our platform to maintain a comprehensive member view and perform reconciliation on prior years.
Late Enrollment Penalty (LEP) Reconciliation
Identify gaps in your LEP administration and premium billing processes. LEP is often reported retroactively and our solution will validate that retroactive reporting of new LEP, changes and removals are accurately reflected in the premium billing.
Low Income Subsidy (LIS) Reconciliation
LIS reporting from CMS is the most challenging for health plans and often leads to more false discrepancies versus true discrepancies that inflate administrative costs. Our solution will reconcile LIS premium subsidy and cost sharing levels with your premium billing system and Pharmacy Benefit Manager (PBM). Comprehensive LIS reconciliation will decrease overrides at pharmacy point of sale and PDE rejections due to inaccurate cost sharing.
Monthly Premium Withholding (MPWR) Reconciliation
Identify members that are not be billed, or possibly double-billed, as a result of premium payment option discrepancies. Our MPWR reconciliation will also reconcile LEP and optional supplemental benefit premium collection for members on SSA/RRB withholding.
Medicare Secondary Payer (MSP) Reconciliation
On average, 50% of the MSP data is outdated or inaccurate when it is reported by CMS. A comprehensive workflow management tool that allows for efficient grouping of records, tracks ECRS submission and has customizable business rules is critical to manage MSP revenue recovery. Our MSP module can reconcile the primacy flags in your claims payment system to ensure that valid MSP flags are in place for cost avoidance.
Our clients experience a high degree of efficiency when pairing the MSP module with the COB module to identify overlaps in the CMS files. Our software alerts the user when the same record appears on multiple files so the record is worked once.
Coordination of Benefits (COB) Reconciliation
Our COB module has extensive logic to manage these complex files to strip out an average of 80% duplicates and records that do not require plan action. Each record type reported can have customized business logic and is based on our extensive experience with the CMS COB files. Our workflow management tool allows health plans to significantly increase the accuracy of their COB processing and decrease the amount of staff needed to administer this process.
Member Correspondence/Letter Management
Our correspondence queue allows health plans to generate CMS required and other plan correspondence. The letter management queue allows for individual letter printing, batch printing, or the creation of a print/mail vendor file in a customizable format.
Link your Finance team and month-end reporting activities directly to the Reconciliation work being performed by the Operations team. Our solution will identify the financial impact of discrepancies and report underpayment and overpayments for accruals.