Enrollment errors don't surface as enrollment problems
They surface as downstream costs. We bring operational excellence to your core admin processes, built across 4M+ enrollments a year for 10 US health plans, at 99.6% accuracy.
12 of Top 15
US health plans
3 of Top 5
Blue (BCBS) plans
100M
lives touched across the value chain
Avasant RadarView™
Leader in Healthcare Payer Business Process Transformation
Everest Group PEAK Matrix®
Leader in Healthcare Payer Intelligent Operations
NelsonHall NEAT
Leader in Healthcare Payer Agility & Innovation
Everest Group
Front-runner in the Generative AI Healthcare Payer Market
NelsonHall
Leader in Healthcare Payer Operational Transformation
ISG Provider Lens™
Leader in Payer Transformation on Healthcare Digital Services
Everest Group PEAK Matrix®
Leader in Healthcare Payer Business Process as a Service Solutions (BPaaS)
WHY THIS MATTERS
What’s breaking enrollment, and leaking revenue downstream
Enrollment errors don't stay in enrollment. They compound across billing, compliance, and member experience.
Admin cost
$131B
US health plan administrative costs nearly doubled, from about $72B in 2014 to $131B in 2024, and labor is roughly 60% of non-medical cost. Enrollment and billing sit in the crosshairs.
NAIC Annual Health Insurance Industry Analysis Report
Medicaid churn
1 in 10
One in 10 Medicaid enrollees loses and regains coverage within a year, and each churn event costs an estimated $400 to $600 in administrative rework. Eligibility and re-enrollment operations sit right in that path.
Commonwealth Fund, Reducing Medicaid Churn, June 2025
Manual reconciliation
>41%
More than 41% of healthcare organizations still run revenue-cycle reconciliation, including premium billing, on mostly manual workflows. Partial or no automation is a direct driver of leakage and compliance risk.
HFMA Automated Payment Reconciliation Survey, September 2025
PROVEN OUTCOMES
What live enrollment automation actually moves
Live results from enrollment and billing programs across multiple US health plans.
4M+
enrollments a year
Firstsource processes more than 4M enrollments a year across 10 health plan clients spanning Medicare, Medicaid, Commercial, and Exchange, at 99.6% accuracy.
99.9%
billing accuracy
Firstsource maintains above 99.9% billing accuracy across member premiums, subsidy payments, and employer contributions on all lines of business.
$10M
in Medicaid premiums recovered
Firstsource identifies eligibility mismatches across 30,000+ Medicaid member records and supports state appeals for retroactive premium reconciliation.
99.9%
saved a month
Reconciliation accuracy holds above 99.7% across active accounts on all lines of business.
Member Enrollment Solutions
Where the enrollment work runs, and where the agent already is
Six stages from intake to configuration. One AI agent running across all of them. Inside your existing core admin. No migration.
Intake validated before it becomes a problem
We validate multi-channel intake from email, fax, EDI, and digital channels at the point of entry. IDP converts unstructured applications into processable records, routing only exceptions to specialists.
- CMS submissions are completed within seven days.
- ID cards are issued within 10 days.
- Core-flex staffing scales to support open enrollment.
Catch the eligibility error before billing does
We perform real-time eligibility checks against CMS, state exchange, employer group, and core administration data. Qualifying event triggers and intelligent exception routing ensure discrepancies are resolved before they enter the billing cycle.
- More than 99.5% CMS acceptance rate
- Exceptions routed with full context for faster resolution
- AI agents automate enrollment workflows
Reconciled in-cycle, not at month-end
We automate invoice generation, match payments across member premiums, subsidy payments, and employer contributions, and detect discrepancies before month-end close.
- More than 99.9% billing accuracy
- More than 99.7% reconciliation accuracy
- Real-time billing dashboards provide operational visibility
- AI agents automate billing and reconciliation
Continuous redetermination
We support the full 6-month redetermination cycle through multi-channel outreach, personalized microsite engagement, and state-certified specialists. Data enrichment and ACA nudges help members at risk complete re-enrollment.
- TCPA-compliant multi-channel outreach to members at risk
- Personalized microsites and portal links simplify member engagement
- Real-time reporting tracks outreach status across all campaigns
Configuration errors are caught before they reach claims
We review benefit designs, test configurations in claims systems, and generate plan documents with quality control and automation that identify configuration errors before adjudication.
- SBC, COC, and EOC documents generated in-cycle
- 99.5% configuration accuracy
- Configuration testing across NASCO, FACETS, HealthRules, and QNXT
Built for the rules you’re audited against
Government-program operations run against CMS and state mandates, with submission accuracy, audit trails, and compliance tracking built into the workflow, across all core admin platforms.
- Medicare: BEQ, MMR, LIS, 99.5%-plus CMS acceptance
- Medicaid: eligibility cycle, disenrollment prevention
- Exchange: APTC, CalHEERS EDI, 99.8%-plus accuracy
- NASCO, FACETS, HealthRules, QNXT, no migration
WHO WE SERVE
Enrollment complexity varies by plan type. We build for yours.
Your line of business determines where the error hides and what it costs downstream.
National plans
Enrollment spans through every line and state
National plans run enrollment across every line and every state. Firstsource processes 4M-plus enrollments a year across 10 plans at above 99.5% CMS acceptance rate.
Blues plans
Premiums reconciled before month-end close
Blues plans reconcile premiums across employer groups, members, and subsidies. Firstsource holds 98% straight-through for Medicaid and 90% for Commercial, matched in-cycle before close.
Self-funded
Open enrollment errors land on the employer book
Self-funded employers carry the downstream claims cost of enrollment errors. The Enrollment Automation Agent validates at intake before errors reach the core admin system or CMS.
PROOF OF DELIVERY
Live enrollment programs, each proving a different result
Reconciliation accuracy, CMS compliance, and redetermination reach. Each from a different live engagement.
98%
reconciliation
Reconciliation runs at 98% straight-through for Medicaid and 90% for Commercial, matching premiums, subsidy payments, and employer contributions in-cycle.
>99.5%
CMS acceptance rate
CMS acceptance held above 99.5% across active accounts, keeping enrollment submissions clean and audit-ready.
24%
redetermination
A redetermination campaign to 11,000 members across three Texas plans drove a 24% completed-application rate, and more than 35% of those who engaged were re-enrolled.
INSIGHTS
Latest from the Firstsource team
Insights from the field, real operations, real outcomes, and perspectives from the people making it work in live operations.
Case Study
Building a strong foundation for growth: how a leading dental plan transformed operations with strategic partnership
Discover how a leading dental plan partnered with Firstsource to transform operations, reduce costs, improve CSAT, and enable scalable growth through AI and a hybrid delivery model.
Contact Us
The cost cascade starts at enrollment. Stop it at intake.
Intake errors that reach CMS are the expensive ones. The agent is scoped from where yours are slipping through.
- Live Enrollment Automation Agent, inside your core admin, no migration.
- Priced on accuracy, CMS acceptance, and turnaround, not headcount.
- Operators running 4M-plus enrollments a year across 10 plans.