We perform Premium Billing & Collection function using Plan specific enrollment data and premium rate information (Plan Bids data). Our premium billing & collection process follows our client’s policies and procedures and complies with CMS regulations. Our Billing system generates monthly premium statements (invoices) which are mailed to the members. We also process premium payment through credit card or EFT. After receiving the payment from a member, we maintain the payment data in our system to allow the premium billing sub-system to generate premium statement by taking into account the payment made by the member. YTD/MTD premium receipt reports are used to follow up with the members for collection.
We also maintain monthly payment records received from CMS, SSA and other agencies like SPAPs. We reconcile payment received with enrollment data by calculating member payments and then comparing with the actual payments received from CMS. All payment discrepancies are reported to the client.
Our P2P process maintains P2P payables and receivables data and reconciles them with actual payments made or received to/from the other Plans. Finally, our financial analyst provides projections for annual CMS payment based on enrollment and other plan specific data.
iProjects Premium Billing and Collection Services @ a Glance
- Generation and validation of premium invoices based on eligibility data
- Mailing of premium invoices
- LEP processing and billing
- Maintenance of members’ premium payment
- Processing credit card payments through third party financial system interface
- Posting and maintenance of payment data received through CMS, SSA and SPAPs
- Generation of outstanding payment report
- Premium refund check processing
- Monthly CMS payment reconciliation
- Maintenance and reconciliation of P2P payables and receivables
- Forecasting of annual CMS payment
Our premium billing & collection process stresses upon generation of correct premium statements taking into consideration of all factors that determines a member’s premium liability. We validate premium payments by comparing a Plan’s member eligibility data to CMS's various membership reports like MMR and identifying discrepancies between actual and expected payments. The payment collection process starts with posting of payment receipts in the system and then periodically producing a outstanding payment report to follow up with the member. The outstanding payment record is used while generating the monthly premium statement. We ensure that our clients receive the correct payment for each Beneficiary.
We reconcile invoices and payments received at every stage to avoid any delay in resolving the discrepancies or issues. Our reconciliation process not only considers the payments received from members or CMS/SSA/SPAPs but it compares the payments with enrollment data. Our annual CMS payment projection is prepared based on inputs like enrollment data, MMR and annual bids data and give projections on various payment components like Direct Subsidy, LICS and reinsurance payment. Finally, we provide standard reports such as payments receipt, projected payments, P2P payment, and outstanding payments as well as on-demand reports to the clients.