The number of Medicare Advantage Special Needs Plans (SNPs) has grown rapidly, offering expansion opportunities but also creating complex enrollment and eligibility challenges. SNPs require pre-enrollment verification and continuous revalidation, especially for dual-eligible members, which can strain resources. Plans must manage seasonal influxes, incomplete applications, CMS updates, and frequent audits, with non-compliance risking penalties or enrollment freezes. Automation and outsourcing streamline workflows, ensure data accuracy, and integrate eligibility with claims systems, enabling faster decisions, reduced errors, and personalized member engagement, while improving compliance and operational efficiency.

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