Streamlining Enrollment Intake for a Regional Medicare Advantage Plan

Client Type: Regional Medicare Advantage payer 
Scenario: During Open Enrollment (AEP), peak Q4 enrollment volumes overwhelmed fragmented intake workflows, causing delays, errors, compliance risks, and higher appeals. 

A Medicare Advantage plan serving 450,000 members faced surges of 5,000–15,000 enrollment forms per day during AEP. Submissions came via paper, fax, email, and online portal, creating silos and manual inefficiencies. 

Key pain points included: 

• Inconsistent metadata tagging and error-prone manual handling. 

• Misrouted packets and delayed exception management. 

• Audit logs failing to capture intake context (CMS compliance risk). 

• Missed SLA deadlines and higher rework/appeals. 

The result: increased operational cost, compliance exposure, and member dissatisfaction. 

Operational Priorities 

The leadership team focused on three critical objectives: 

• Accelerate intake-to-activation to meet CMS-mandated timelines. 

• Reduce manual errors and misroute to improve accuracy. 

The payer piloted a unified intake orchestration framework, inspired by digital mailroom best practices. Key elements included: 

• Real-time document capture & classification across all channels. 

• Metadata validation at receipt (e.g., member ID, plan type, effective date). 

• Rule-based automated routing by form type, urgency, and member profile. 

• Exception queues for low-confidence OCR, missing data, or flagged entries. 

• Embedded quality checks at the intake layer for proactive accuracy. 
  utcome Metrics 

• Reduced reliance on seasonal staffing → lower cost, stable workforce. 

• Improved enrollment accuracy → faster ID card issuance and cleaner member data. 

• Increased claims throughput → fewer downstream corrections. 

• Stronger compliance → audit trails now track intake timestamps, metadata, and routing. 

Insights for Payer Leaders 

1. Intake quality is a multiplier: Errors at intake ripple through claims, service, and compliance. 

2. Proactive QA at intake > downstream fixes: Prevention saves cost and protects compliance. 

3. Automation should augment, not replace: Orchestrate around existing systems for faster adoption. 

4. Compliance strength starts at intake: True CMS readiness comes from traceability, not retroactive fixes 

Forward-Thinking Takeaway 

As Medicare Advantage enrollment grows in volume and complexity (condition-specific plans, dual-eligibles, supplemental benefits), intake orchestration becomes the foundation for scalability. 

Treat intake not as a static entry point, but as a strategic control hub for quality assurance, member activation speed, and claims readiness.