1. July 1
2010
Product
Overview
Voyager
The information in this document is confidential and the property
Dynamic Healthcare Systems, Inc. Enterprise
Software
Smarter Technology.
Smarter Solutions.
DYN-XX-201007

2. Voyager Enterprise Software
VOYAGER ENROLLMENT AND MEMBER MANGEMENT
The Dynamic Advantage
Dynamic is the leading enterprise software and solutions company for health plans that manage
Medicare Advantage (MA) lines of business. Every MA plan depends on the accuracy,
effectiveness and efficiency of their enrollment and member management group. The
Voyager® Enrollment and Member Management Modules provides the enterprise infrastructure
and tools to Reduce Costs, Accelerate Revenue and Maintain Compliance Requirements.
Smart Costs
Since health plans are required to limit their administration costs, the Voyager® enterprise
application is designed to scale with a plan’s growth, without requiring additional full-time
resources. Voyager’s eligibility verification engine uses CMS’ recommended Batch Eligibility
Query (BEQ) and a set of auto-adjudication rules to quickly evaluate 98% of the elections and
determine who should be enrolled, denied and require further review. Voyager’s eligibility and
Transaction Reply Report (TRR) processing engines will allow for automatic member data
updates and generation of required correspondence, reducing manual efforts, improving data
accuracy and reducing compliance risks.
Smart Revenue Cycle
Premium pressures and decreased processing transaction timelines require plans to accurately
submit and process transactions timely. Voyager’s data validations and compliance reporting is
used to identify and eliminate ‘Avoidable Submission Errors’ to CMS, reducing errors, appeals
submissions and the CMS premium payment cycle. The Voyager Reconciliation module is
integrated with the Enrollment and Membership modules allowing for seamless and timely
evaluation of plan data and effortless correction of plan errors. Correct payment requires the
plan to track and maintain an accurate view of their member’s demographic and special status.
Voyager allows the plan to track every attribute including start and end dates to ensure accurate
views of the member for each payment month.
Smart Compliance
Voyager is designed to ensure a plan stays in compliance with CMS enrollment policies. The
plan can assign and monitor required tasks using integrated work queues and workflows.
Required correspondence is always triggered based on events and is easily accessed to review
within Voyager. All changes to Election and Member information are stored with a detailed audit
Confidential, Dynamic Healthcare Systems, Inc
DYN-XX-201007
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3. Voyager Enterprise Software
trail. Standard and customer reporting allows the plan to monitor tasks, turnaround times and
compliance risks. Voyager uses an enterprise role based security platform, allowing users to
only access the information that they need to perform their work, complying with HIPPA and
SOX security and privacy requirements.
Dynamic Services
The Dynamic solution recognizes that your success depends on a combination of superior
software and service. Our team’s expertise in Medicare plan operations allows us to partner
with customers to deliver the solutions they need when they need them.
• Audit of Plan Enrollment Operations for Compliance and Best Practices
• Mock CMS Enrollment Process Audit
• Enrollment policy and compliance training
If your plan has been disappointed with previous vendors nickel and diming you for each call,
email and question answered; or sold a bill of goods that does not exist; or does not really
understand your challenges in your marketplace – Then it is time to call Dynamic Healthcare
Systems.
Voyager
• Security: Role based security allows plan to meet their HIPPA and SOX security
and privacy requirements.
• Web Application: Voyager is designed to use the latest in JAVA and web based
enterprise software technologies. Plan IT departments are largely un-effected by
leveraging existing investments in hardware, software and user training.
• Integrated Data Model: Voyager’s integrated data model allows Voyager modules
to share data and provide a 360 degree view of the membership.
Enrollment
• Election Data Validations: Improve data quality using online data validation rules
and real time U.S. Postal Service address validations
• Correspondence Management: Manual and automatic letter creation and
retrieval of historical letters
• BEQ and TRR Processing: Automate actions based business rules for processing
BEQ and TRR transactions.
Confidential, Dynamic Healthcare Systems, Inc
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4. Voyager Enterprise Software
• Integrated Workflow: Voyager’s integrated work queues ensure required tasks
are assigned and completed.
• Auto/Facilitated Enrollment Processing: Part D plans can process auto and
facilitated enrollees in the plan.
• Reporting: Standard and Custom reporting provides unlimited view of the your
business
Member Management
• ECRS and COB Processing: Create ECRS submission files and process COB files to
ensure accurate Part C and D COB data.
• Complete Member Information: Store and maintain complete member
demographic and special status information with start and end dates.
• Integrated Reconciliation: Voyager Member data is shared with the Reconciliation
module providing a direct view of the impact of plan data changes and
corrections
Confidential, Dynamic Healthcare Systems, Inc
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5. Voyager Enterprise Software
RECONCILATION
Medicare Advantage health plans
are required to attest that CMS
payment reports (MMR) are correct
and accurate with their internal
records. Dynamic’s reconciliation
module allows a plan to easily load
their bid information and MMR and
quickly identify member, special status and payment discrepancies.
Focus On the Bottom Line
• Idenitfy prospective payment and retrospective adjustment discrepancies
• Member discrepancies are quickly identifed and sent to the enrollment group for resoluition
• Special Status discrepancies are captured where corrections can be make to either plan data
or appeals to CMS
• Identify payment level discrepancies indicating issues with bid information or CMS payment
processing errors.
Resolve Discrepancies
• CMS is Wrong – Send appeals to CMS to correct member and special status discrepancies
• Plan is Wrong – Correct plan information in Voyager and recalculate payments to resolve
internal data errors
• Track Discrepancies to the Member Level – Voyager will track payment issues to the
member level. Showing what payment calculations are discrepant with CMS.
Confidential, Dynamic Healthcare Systems, Inc
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6. Voyager Enterprise Software
PREMIUM BILLING
Managing your Medicare Advantage and Part D billing has never been easier. This full-featured module
integrates up-to-the minute member subsidies and late enrollment penalties and complete tracking of
prospective and retroactive enrollment actions to provide simple, compliant billing and premium
management.
• Calculate member premiums and refunds
• Retroactive adjustments for enrollment/disenrollment activity
• Reconcile SSA Premium Withhold
• Invoices, statements and coupons, with re-prints
• Manage SPAP and other third-party payors with split bills
• Employer groups
• Low income subsidies
• Late Enrollment Penalties
• Auto-draft/direct debit with pre-notes
• Grace periods and late payment arrangements
• Age outstanding balances and manage delinquencies
• Trial bills
• Customized GL exports
• Lockbox remittances with automatic or manual allocation
Confidential, Dynamic Healthcare Systems, Inc
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7. Voyager Enterprise Software
HCC ANALYTICS
Risk Adjustment is far more than a data collection project… it drives your bottom line.
A single missed diagnosis can cost thousands of dollars. HCC Analytics examines all source data to
identify suspect, missing or incorrectly coded diagnosis codes – the foundation of your risk adjustment
factors.
Target Suspects
• Manage diagnosis data from a variety of sources – including claims data, pharmacy
encounters, chart audits and more.
• Detect suspect missing diagnosis codes from historical encounter data.
• Store and report in a member's HCC history
• Calculate RAF scores based on varied collection and cut off dates
• Quickly enter and validate updated diagnosis
• Plan defined validation rules library
• Member level suspect list of missing ICD9 codes and coding errors
• Project future RAF scores
• Substantial Report Library
Confidential, Dynamic Healthcare Systems, Inc
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8. Voyager Enterprise Software
RAPS MANAGEMENT
RAPS Management Module allows a health plan to import, submit and reconcile the submission of RAPS
encounter data with CMS.
• Contains a rules engine that validates data reducing rejections and resubmissions to CMS,
reducing costs
• Improves the quality of data submitted to CMS. Provides for manual entry of RAPS data
• Validates and edits RAPS data before submission to CMS
• Resubmits corrected RAPS data to CMS
• Reconciles RAPS reply fields with submission files to the encounter level
• Submits all RAPS data to CMS for Part C & Part D
• Tracks, ages and provides management reports for data sourcing, uploading and
reconciliation with CMS
• Imports RAPS, member and provider data from legacy claims system
Confidential, Dynamic Healthcare Systems, Inc
DYN-XX-201007
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9. Voyager Enterprise Software
CHART AUDIT TOOL KIT
The Chart Audit Toolkit allows plans to manage and monitor
their retrospective and prospective risk adjustment programs.
• Project Creation – Users can create custom chart
audit projects by adding charts related to members
and or providers
• Planning and Scheduling – Assign charts to auditors
and vendors, schedule and confirm provider
appointments
• Project Monitoring – Visibility of project status and
monitor progress of any program
• Record and track results for ROI – Auditor either
enters the diagnosis results from their audit using
the web interface OR upload excel spreadsheets in
to the application allowing for ROI reporting by
project and RAPS submission
• Generate Auditor Field Packets – At the touch of a button, auditors can quickly and
painlessly create and print auditor packets that contain critical information for going in to
the field. Packets include, Provider Chart Pull List with Provider Contact Information; Maps
displaying the offices for each provider; and detailed problem and suspect list for each
member that will be audited.
Confidential, Dynamic Healthcare Systems, Inc
DYN-XX-201007
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10. Voyager Enterprise Software
PDE MANAGEMENT
PDE Management allows a plan to monitor the PDE data submissions from their PBM and track PDEs
that are accepted and rejected and why.
Plans are responsible for complete submissions of PDE data reporting with little ability to monitor the
results of their PBM’s data submissions and resubmissions.
• Monitor PDE Errors – Report and track PDE errors on PDE transactions by error code and
group by type of error
• Correct Errors - Create and queue corrective action tasks to resolve PDE errors and ensure
acceptance of PDE transactions
• Identify Error Causes – Side by Side views of PDE and Drug Claim data allows for quick
identification of differences and discrepancies
• Work Flow – Use automated and manual work queues to track error resolution for PDE
transactions that have been rejected
• PDE History – PDE submission and history are created showing what PDE transactions have
been created, stored, submitted and deleted.
Confidential, Dynamic Healthcare Systems, Inc
DYN-XX-201007
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11. Voyager Enterprise Software
PDE AUDIT
PDE Audit allows a plan to calculate an internal view
of PDE transactions based on actual Drug Claim,
formulary, benefit design and membership data.
Allows the plan to identify covered drug claims that
should have been reported and were missed and
verify the accuracy of the cost and payment fields.
• Monitor PDE Content Errors – Easily
identify PDE calculation errors in cost and payment fields
• Verify Paid Drug Claims Are Reported – Identify covered drug claims that have not been
reported to CMS and should have been reported to be correctly reimbursed by CMS
• Identify Mis-Reported Values – Quickly find PDE transactions that have not been
retroactively processed for changes in Member Data like retroactive LICS changes
• Verify Claims are Adjudicated in the Correct Benefit Phase – Internal view of PDE
transactions provide a discrepancy where PDEs have been processed in the wrong benefit
phase because of incorrect TROOP or Gross Covered Drug Cost Tracking
Confidential, Dynamic Healthcare Systems, Inc
DYN-XX-201007
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