Member Management

Member Management

Our member enrollment services reduce the administrative burden and cost to support member enrollment processes. Our eligibility and benefits configuration, backed by our knowledge-based platform, addresses the recurring industry problems with inaccurate benefits configuration. Utilizing this leads to a reduction in improper claim payments and a decrease in appeals and grievances.

1. Eligibility and Enrollment

Santric Technologies Private Limited manages the eligibility and enrollment process for our clients, including the verification and determination of each member’s coverage to help automate the process and free up necessary resources.

Santric Technologies Private Limited’ skilled team of subject matter experts manages the eligibility and enrollment process for our clients, including the verification and determination of each member’s coverage specificity. Delegating this task to Santric Technologies Private Limited allows your organization to free up resources and concentrate on core business functions that optimize internal operations.

Santric Technologies Private Limited ’ skilled SMEs identify the patient/member to determine:

  • If the member or dependents are covered by an active policy or plan
  • If the member or dependents needs to be enrolled
  • If the member and dependents’ opted coverage has a valid coverage period to enroll

Our eligibility and enrollment solutions handle

  • Switching over plans from the previous year and initiating the coverage under new plans
  • Ensuring the correct PPO coverage is linked to each member in the case of commercial payers for small groups
  • Making sure the defined stop loss coverages are linked to correct groups
  • Capturing and checking the patient information against the eligibility database

Santric Technologies Private Limited has multiple technology-enabled solutions to make ease of your enrollment process. The enrollment process is streamlined through web-enabled programs or through our own enrollment application. To address the changing needs of our clients, we have developed a mobile application that is completely customizable. This technology eases the entire process and reduces manual errors wit

  • Fulfillment services with assembly and distribution of new member materials
  • Group/membership enrollment and maintenance
  • Electronic enrollment processing
  • Identification card production and mailing
  • Maintenance of ID card stock

Some of the key business areas Santric Technologies Private Limited handles in the enrollment are:

  • Health insurance enrollment forms processing assistance
  • Life insurance enrollment forms processing assistance
  • COBRA enrollments
  • Flex enrollments
  • Life insurance
  • Auto insurance
  • Domestic and international travel insurance

2. Premium Invoice Billing

Invoice billing is the process of generating invoices every month for premium collection. Santric Technologies Private Limited helps our clients generate monthly invoices to collect monthly premiums from each employer group. Our premium invoice billing solution streamlines invoice processing, allowing your organization to reduce costs, gain greater control over accounts payable, and save valuable time.

Our ground-breaking solutions include:

  • Making enrollment changes (the addition of members to an employer group or changes to that group)
  • Adjusting the premium amount of each employee based on changes in plan enrollment
  • Billing calculations (generating individual invoices for an employer group based on the starting or ending date of employment, premium rates based on coverage selection, TPA administration fees, and brokers’ commissions)

3. Member Mobile App

In today’s world of on-demand technology, it is imperative that third-party administrators (TPA) have a mobile app for its members.

Although several TPAs have a web portal for members, a mobile app is more user-friendly and convenient, as members can access all the information they need at their fingertips. Santric Technologies Private Limited has built and supports a number of member mobile apps for TPAs.

Our member mobile apps provide the following features:

  • ID Card: Removing the need to carry a physical ID card every time you visit a provider
  • Coverage: All plan-covered categories are listed for easy access
  • Patient responsibility information, including deductibles and out-of-pocket information
  • Claims: Claims history for the covered period is listed along with any ongoing claims’ status
  • Find a doctor: A list of all contracted providers with their specialty information and location
  • Teleconferencing: Attend a conference on the go