Membership Reconciliation


Infogix is the leader in providing healthcare payers with comprehensive membership reconciliation. Our solution easily executes complex rules that automatically run in the background to catch membership errors at the source, and provides continual monitoring to ensure maximum data integrity from source to destination. Payers can rely on the continued integrity of their data, and additional value is delivered through 100% visibility into all reconciliation points. Flexible reporting and dashboards assure quick notice of error and allow for prompt prioritization and resolution of exceptions.

Validating membership for completeness up front in the process saves headaches in the form of time and money when incomplete or incorrect data is not reconciled. Finding reconciliation issues early on speeds up the member enrollment process and avoids errors that can pollute other downstream processes. When membership errors are found too late, investigation and correction can be time-consuming, and resultant delays can cause both embarrassment and customer service issues. A front-end solution will prevent the root cause of bad membership data that often corrupts a complex web of systems that depend heavily on accurate membership information.

Automated membership reconciliation provides the peace of mind that all systems are performing flawlessly, and operational efficiencies are maximized. And when an error occurs, it’s quickly flagged to be fixed before it can impact your members, business, or bottom line.


Membership Reconciliation


Specific analysis provided around Membership Reconciliation includes:

  • Reconcile data between membership portals and internal systems
  • Reconcile between the issuer’s and government’s membership data (e.g. 834 files, Pre-Audit and RCNO)
  • Detect duplicate file submission
  • Flag incomplete data submission


How We Can Help

By performing reconciliations related to your group, individual, and Federal/State exchange-driven membership, you achieve membership data accuracy, thus capturing all available revenues from new members and government subsidies. You will also ensure regulatory compliance, avoid misreported enrollment information and associated fines, and minimize customer service issues.