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Beneficiary Payment ReConciliation Module

Medicare Beneficiary Payment Reconciliation module from GWI's CMS Gateway^TM enables us to provide real-time datawarehousing after enrollment to provide payment reconciliation on beneficiary to their specific Medicare Advantage Health plan.

When GWI's Payment ReConciliation module in integrated with the rest of our value added services, GWI CMS Gateway^TM can allow all payments allotted and paid to the specific beneficiary detailing retrospective payments reconciliation from Medicare beneficiaries enrollment in health plan for future billing purposes.

As a part of our CMS Gateway^TM services, GWI's payment reconciliation module allows Medicare Advantage Plans to enroll beneficiaries and manage the financials on every beneficiary by saving time in redundant paperwork.

Individual billing including online payments, automated commission payment including retroactive adjustments

• Modify payment dates of disenrollment
• Payment with Risk Adjustment factors
• Weekly and monthly payment reconciliation reports

Group Maintenance
• Group setup
• Group benefit plan
• Group inquiry
• Authorization and pre-certifications
• Rule-based auto-authorize

Benefit Setup
• Benefit plan maintenance
• Benefit plan copy option
• Riders
• Insurance product maintenance
• Multiple benefit plan payment options
• Payment option supports granularity to level of benefit category

Data Exchange
• Dynamic and static reports and letters
• Privileged access using role-based security
• Static, event-driven and scheduled reports/letters
• Export options to multiple formats

Provider and Pricing
• Provider setup
• Maintain a number of standard and specific fee schedules
• Provider specific and generic contracts

Professional, Institutional and Pharmacy Claims
• Complete EDI setup
• Make payments
• Payment enquiry
• Check printing
• Notifications (EOB/EOP)