INFOGRAPHIC:
4 Ways to Tighten Open Enrollment Eligibility Checks
With open enrollment season upon us, are you prepared for the wave of changes to individual insurance coverage? A proactive approach will help you obtain accurate coverage information, avoid unnecessary claims denials, and achieve timely reimbursements.
Why Open Enrollment Eligibility Checks Matter as Coverage Changes
Patients and residents are changing their insurance coverage by the millions, and enrollment in federal- and state-run marketplaces, Medicare, and Medicare Advantage is growing.
21.4M
Consumers who selected or were automatically re-enrolled in government-run marketplaces during the 2023-2024 open enrollment period1
5.1M
Additional consumers who signed up for coverage during the 2023-2024 open enrollment period compared to the year prior1
41%
The year-over-year increase in new consumers selecting marketplace coverage during the 2023-2024 open enrollment period1
50%
The portion of Medicare beneficiaries enrolled in Medicare Advantage in 2023, up from 17% in 20002
11.4%
The increase in the number of Medicare Advantage plan options available to consumers between 2019 and 20233
4 Tips for Open Enrollment Success
Monitor eligibility
on a regular basis
Run recurring batch eligibility checks on your patient or resident census to identify changes in a timely manner. Reduce the risk of claims denials with automatic enrichment of incomplete transactions from payers.
Identify all
available coverage
Discover unknown or undisclosed insurance coverage with basic patient or resident details. Validate demographic details instantly for more accurate results and a faster path to treatment.
Keep tabs on Medicare
Eliminate costly compliance errors by obtaining automatic weekly verification on Medicare eligibility and Medicare as a secondary payer.
Leverage automation
Reduce errors and minimize denials by running eligibility checks on all payers when a claim is uploaded. Streamline claims resolution by automating workflows for audits and appeals.
$154 million
Potential revenue gain for providers by discovering all billable coverage4
Spot Insurance Changes Before They Slow Down Revenue
Learn how end-to-end RCM solutions can simplify workflows, save staff time, and keep cash flowing smoothly.
- Health Insurance Marketplaces 2024 Open Enrollment Report, Centers for Medicare & Medicaid Services, https://www.cms.gov/files/document/health-insurance-exchanges-2024-open-enrollment-report-final.pdf
- Harvard-Inovalon Medicare Study: The Importance of Plan Design in Medicare Advantage, https://www.inovalon.com/resource/harvard-inovalon-medicare-study-the-importance-of-plan-design-in-medicare-advantage/
- Medicare Advantage 2023 Statistics and Data, American Association for Medicare Supplement Insurance, February 23, 2023, https://medicaresupp.org/information/
- Inovalon internal reporting, 2022. Realization of reimbursement for identified coverage may vary; dependent upon payment process
