Medicare Advantage Solution

HSP offers an integrated, comprehensive Medicare Advantage solution that is embedded within the core system to support simplification and automation for administrative and regulatory requirements.

The HSP Medicare Advantage solution supports the delivery of quality care while meeting complex regulatory requirements of CMS. With the HSP solution you can achieve required interaction with CMS for enrollment, EDPS and RAPS. You can also address new opportunities such as dual-eligibility administration, maximize CMS Star ratings and elevate the customer service experience for members and providers. With our efficient and compliant, automated technology you can rapidly manage and grow your Medicare Advantage business while optimizing revenue and managing risk.

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Automate and Simplify:

  • Compliance Management
  • Pre-Enrollment
  • Enrollment
  • CMS Submission & Reply (D/MTRR) Workflow
  • CMS Claims / Encounter Submissions (RAPS / EDPS)
  • CMS Compliant Letters, ID Cards and Fulfillment Packages
  • CMS Correspondence Requirements: Multiple Languages and Text Fonts
  • Premium Billing
  • Enrollment and Premium Reconciliation
  • Dual Eligible Management
  • HCC and Risk Adjustment Reconciliation
  • Managing Operational and Financial Performance in Real-Time
  • Concurrent STARS and Quality Measurement Management
  • Customer Service Processing
  • Grievances and Appeal Processing
  • Enterprise-Wide Workflow
  • Audit Management
  • Integrated Care Management Processing
  • Regulatory Reporting Requirements
  • CMS Provider Reimbursement Methods