1.
© FIRSTSOURCE 2023 | CONFIDENTIAL | 1
Enrollment &
Billing Overview

2.
© FIRSTSOURCE 2023 | CONFIDENTIAL | 2
Endto EndServiceProviderforEnrollmentProcesses
Improve STAR Rating | Reduce Cost of Operations and Print | Reduce Member Calls
End 2 End Services
Mailroom Processing, EDI,
Enrollment, Billing, ID Cards,
Compliance, Hyper Automation
Member Churn
Reduce member churn and predict
member behavior from historic data
and market trend by using Data
Analytics
Operational Powerhouse
Track, administer and reconcile transactions/members from
Group set up to Enrollment to ID cards and letters to ensure
compliance and improve CX
Automation
Minimal manual touch through
automation at various stages from
Enrollment to submission to CMS
and to ID card/letters to improve
accuracy and member experience.
Business
Outcomes

3.
© FIRSTSOURCE 2023 | CONFIDENTIAL | 3
EnrollmentandBillingExperienceandCredentials
4 M+
Volume Processed
Annually
8
Health Plan Clients
99.9%
Accuracy for
CMS Acceptance
99.9%
TAT
Compliance
980
Experienced
Examiners
99.6%
Enrollment
Accuracy
99.9%
Billing
Accuracy
99.7%
Recon
Accuracy
Member & Group
Recon and Inquiry
Sales Agent Mgmt/
Broker Setup
Benefit Validation &
Testing
New Member Enrollment
Member/ Groups Renewals
Reconciliation
Missing Information
Rejection
Data Capture
PROCESSES
Data Enrichment Reporting
Billing Installation &
Reconciliation
LOBs - Medicare, Medicaid, Commercial, ACA, FEP
Platform Agnostic
HealthRules | QNXT | Facets | ELEMENTS | AX | EZR | EDS | MHS | BizTalk | Pega | SSRS

4.
© FIRSTSOURCE 2023 | CONFIDENTIAL | 4
MembershipValueChain
• Business Rules
Configuration
• New Group Addition
• Benefit Changes
• Group maintenance
• Yearly renewals
• Member Addition
• Member
Modification
• Member
Disenrollment
• EDI / OEC / Paper
processing
• Eligibility
verification&
maintenance
• ID card and
Welcome Kits
• PCP
• Newborn
• Invoice Generation
• Premium Billing
• Cash Posting
• Payment
Reconciliation
• Research Payment
• BEQ validation
• TRR/TRC processing
• MPWR processing
• FRM process
• Subsidy
management
• RFI/LIS/LEP
• CMS and State
Governance
• Daily Inventory
Monitoring
• Daily Aging Review
• System Application
Recon Process
• Letter Tracking
• Client Visibility /
Reporting
Group Set Up
Enrollment
Processing
Billing &
Reconciliation
CMS Processes
Governance
Model
Agent
Management
• Broker Addition
• Maintenance (Renewal,
Terms, Demo changes)
• Group Affiliation
• Commission Payment
Adjustments
Broker management – only
for commercial
• Commission decided by
the client for
commercial but for Care
based on CMS
guidelines
• DFS – department of
Financial Services
• Commissions – approx.
4% of the premium,
FMO - Field Marketing
Organization

5.
© FIRSTSOURCE 2023 | CONFIDENTIAL | 5
EnrollmentInventoryDashboard

6.
© FIRSTSOURCE 2023 | CONFIDENTIAL | 6
EnrollmentPerformanceDashboard

7.
© FIRSTSOURCE 2023 | CONFIDENTIAL | 7
EnrollmentQualityDashboard

8.
© Firstsource Solutions Limited | Confidential |
www.firstsource.com
Helping customers stay ahead of the
curve through transformational
technologies and capabilities
Firstsource Solutions Limited, a RP-Sanjiv Goenka Group company, is a
leading provider of transformational solutions and services spanning the
customer lifecycle across Healthcare, Banking and Financial Services,
Communications, Media and Technology and other industries.
Our ‘Digital First, Digital Now’ approach helps organizations reinvent
operations and reimagine business models, enabling them to deliver
moments that matter and build competitive advantage.
With an established presence in the US, the UK, India and the
Philippines, we act as a trusted growth partner for over 100 leading
global brands, including several Fortune 500 and FTSE 100 companies.