Case Study: Top Five Healthcare Payer Organization achieves automated, accurate 834 membership reconciliation with Precisely

Automating Reconciliation of 834 Membership & Enrollment Data

Top Five Healthcare Payer Organization, a customer‑owned insurer serving over 10 million members and employing 15,000+, faced a complex, manual 834 membership and enrollment reconciliation process. Incoming 834s flowed through an EDI gateway, an editing system and a proprietary membership system with 999 acknowledgements exchanged, and missing or inaccurate data required time‑consuming manual checks that risked incorrect coverage, card mailings and compliance gaps. The organization engaged Precisely (Precisely Strategic Services and the Insight reporting capabilities) to address these challenges.

Precisely deployed an automated, end‑to‑end reconciliation solution with data extraction at the gateway, editing system and membership system, automated validations that balance member counts across interfaces and monitoring of 999 acknowledgements, plus real‑time reporting, trending and exception analytics via Insight. As a result, Precisely delivered an automated reconciliation process with real‑time alerts and exception reports that reduced administrative costs and resolution time, made policyholder data more reliable and provided the audit trail needed for compliance.