Automating Reconciliation of 834 Membership & Enrollment Data

Closing the Information Gap on 834 Enrollment Data Flow

Founded in the 1930s, this customer-owned healthcare payer serves over 10 million members in multiple states. It provides typical coverage for individuals, families and employer groups. It also provides additional coverage including dental, life and disability via its subsidiaries and affiliates. As one of the top five health insurers in the U.S., it employs over 15,000 people, with continual growth projected.

As with other healthcare payer organizations, this longstanding customer relies on the accurate operation of essential systems to process critical membership and enrollment data.

The Challenge

The 834 membership reconciliation process is a multi-step, complex process. This organization’s membership data is originated by a third party and enters the insurer’s system through a gateway. From there, the data passes through an editing system where necessary transformations take place. A mandatory 999 acknowledgement is created and sent back through the gateway to the third party, acknowledging receipt of the data. Ultimately, the membership data resides in the proprietary membership system. The same systems are involved with the outbound 834 process.

To learn more read the full customer story.