Eligibility and Enrollment

Streamlining and strengthening eligibility and enrollment processes in Federal and state healthcare programs reduces cost of care, promotes access to care, and improves the beneficiary experience. Through our unique blend of innovative technologies and state-of-the-art citizen engagement infrastructure, we give Federal and state healthcare authorities the ability to rapidly implement complex and ever-changing eligibility rules and the ability to engage eligible beneficiaries in clear and well-informed enrollment processes.


Eligibility Determination

Enrollment Support

Appeals Processing

Program Integrity

Our eSante EnGage360™ platform is a multichannel contact solution that builds on our proven customer assistance solutions to achieve program excellence in eligibility determination and health plan enrollment. We help customers improve plan selection rates among uninsured and underinsured populations through comprehensive education and outreach; omnichannel customer assistance, data-driven program optimization, enrollment support, and streamlined case management leveraging the following capabilities:

  • Application processing focused on accuracy and timely completion, including software-assisted data validation
  • Consumer education and outreach programs designed for specific state demographics and populations
  • In-person enrollment assistance to help states reach, educate, and enroll prospective beneficiaries, including special populations
  • Accessible, self-service options to help connect members with their healthcare options

Cognosante Team to Provide Enrollment Assistance as Pennsylvania Moves to a State-Based Insurance Exchange

FALLS CHURCH, VA – The Pennsylvania Health Insurance Exchange Authority has awarded a contract to Cognosante, LLC to provide Exchange Assister and Navigator services in support of the Commonwealth’s newly formed state-based health insurance marketplace named Pennie. Under the contract, Cognosante and its teaming partners will provide outreach and no-cost enrollment assistance across Pennsylvania to […]

State health and human services

Cognosante Awarded New Community Care Referrals and Authorizations (CCR&A) Contract

FALLS CHURCH, VA–October 8, 2019–Cognosante has been awarded a contract to continue providing development and support services for the Department of Veterans Affairs Community Care Referrals and Authorizations program. The new task order will allow Cognosante to continue its implementation of the VA’s Health Share Referral Manager (HSRM), an enterprise-wide system used by community care staff […]

Automating case resolution in the Marketplace

CONTEXT As part of the Affordable Care Act, taxpayers who obtain insurance through healthcare.gov receive a 1095a tax form which explains their coverage and any premium tax credit they have received. It is then used to reconcile any coverage detail discrepancies reported by the consumer after receiving the form at tax time. A case must […]

Data and Technology

Enabling increased access to care for Veterans

Context Cognosante contracted with a U.S. government department which has a goal of providing eligible Veterans with the care they need at the right time, at the right place, from the right provider, which in some cases is a local community care provider. To meet this goal, they offer referrals to community providers and decrease […]

Military and Veterans' health

Performing independent security assessments

Context To implement key provisions in the Affordable Care Act (ACA), Centers for Medicare and Medicaid Services (CMS) provides matching funds to state health agencies for major health information technology (IT) initiatives. State health agencies receiving Federal funding to implement their health IT solutions must adhere to security requirements specified by CMS in the Minimum […]

Federal health programs

How Cognosante uses process improvement to make healthcare work better

At Cognosante, we work to provide our customers with transformative solutions. We constantly look for ways to deliver on our core mission: to improve the U.S. healthcare system through a fundamentally different approach to information technology and customer service. One way Cognosante achieves that goal is through a deep commitment to process improvement, a powerful […]