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.

Services

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

National Military Appreciation Month: Improving Veteran Healthcare Through Innovative Technology

In honor of National Military Appreciation Month, we’re proud to feature Cognosante leaders who support military and Veteran missions through the work they do for our customers. We spoke with Erick Peters, Chief Technology Officer at Cognosante, and a Navy Veteran. He shares his perspective on how innovative technology is improving healthcare for Veterans.   Erick, […]

Summer Analysts Trained and Certified as Cognosante Lean Six Sigma Yellow Belts

Cognosante’s Internship program offers aspiring young professionals the opportunity to learn skills and knowledge through individual and group project experiences, plus through hands–on training and certifications. During an internship with Cognosante, Summer Analysts can expect to gain a combination of real–world business problem solving and professional development through training activities, which collectively will prepare college students for their first steps into a career.   Types of Training and Certifications that Cognosante Offers […]

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 […]

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 […]

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 […]