Eligibility and Entitlement

Eligibility and Entitlement

Eligibility and entitlement information must be verified for many public benefits programs before services are rendered. Beginning with the initial development effort and the subsequent launch in 2014 of the health insurance marketplace (www.healthcare.gov), eSimplicity’s team supports the implementation of complex eligibility and entitlement criteria that spans many federal and state data sources and continuously analyzes website data and user behaviors. eSimplicity modernizes legacy beneficiary and eligibility systems that allow downstream systems and programs to obtain real-time eligibility information; moves eligibility and entitlement information and its API to the cloud to streamline operations and lower maintenance cost; and uses real-time integration with a data service hub so the CMS team can accelerate the eligibility determination process, reduce errors, and elevate user experience.