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Eligibility Management

Experience a faster, easier and more complete way to verify eligibility. Use automated verification with unique real-time batch processing through a direct gateway connection to payers. Benefit from our years of experience interpreting health plan data files.

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Manage Eligibility Updates
and Comprehensive Enrollment

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Easily Configurable

Eligibility Manager makes it easy for IPAs, MSOs, or any population health, delegated group, or managed care organization to efficiently manage changes to healthcare member eligibility. Users can effortlessly reconcile their own data against data from all payers. The program takes a full or partial list of members from a health plan as input and creates a list of membership changes.

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More Functionality

Not only will you have a high level of control over your eligibility data while having the ability to in-load and accurately audit quickly, but you can also identify members that have dropped from the health plan list as well as manage any number of entities contracted with any number of plans.

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Fully Customizable

Eligibility Manager is fully customizable to load and export eligibility data in any format, including ANSI X12 HIPAA formats. Combined with DataTug™, Eligibility Manager enables users to save hours with automatic online eligibility verification.

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Next Level Design

What sets this solution apart from others? First, its unique design allows for implementation of custom processing for any health plan data format, health plan data issues, and client business rules. Second, powerful yet easy-to-use auditing tools enable eligibility analysts to quickly find and correct data issues.

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Go Further with Automated Eligibility Data Verification

DataTug™ is a unique product that quickly and accurately provides eligibility verification for any health plan, saving you time and effort, and increasing your productivity. Using a flexible data interface that allows for searches of members in multiple file formats, DataTug extracts required data automatically from health plan websites and ANSI X12 270/271, and other data portals.

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Serving

payers

Payers

Manage risk more effectively and obtain greater value for every healthcare dollar.

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providers

Providers

Act on emerging opportunities to transform operations and improve financial performance.

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employers

Employers / ASOs

Recognize high-value innovation opportunities in healthcare with our help.

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Eligibility Manager – Accurate Eligibility

Experience a faster, easier and more complete way to verify eligibility.

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DataTug – Automated Eligibility Data Verification

Verify Eligibility Data in Real-Time

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SOLUTIONS

Cedar Gate’s enterprise performance management analytics and administration platforms reduce risk, enhance financial performance, and improve patient outcomes for healthcare organizations across the value-based care continuum.

Enterprise Data Management

Capture, organize, and utilize all valuable data sets securely and easily.

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Empower your team with timely information to take action and reach performance goals.

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Transform the way you report on your business with these intelligent tool sets.

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Support medical management activities across the care continuum.

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Manage patients effectively from chronic conditions to transitions of care.

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Administer retrospective and prospective bundled payment arrangements with clinical excellence.

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Operate multiple lines of business with claims and benefits administration, eligibility, capitation reconciliation, financial management and more.

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Extend your effectiveness with managed, professional, or advisory services.

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