Live Operations View
Medicare MAPD Enrollment Operations Dashboard
Medicare Enrollment Operations · National Health Plan
Plan Type
Period
Key Performance Indicators
Active Enrolled Members
874,312
▲ 3.1% vs prior period
MAPD + PDP combined
New Enrollments (Period)
31,458
▲ 8.3%
vs same period prior year
Auto-Processing Rate
91.7%
▲ 2.4 pts
Target: ≥ 90% · Threshold: 82%
Pending Reconciliation
2,193
▼ 14.6% vs prior week
Dual-ID resolution queue
Revenue Reconciled
$563M
▲ 4.2%
CMS premium payments received
Enrollment Pipeline
Enrollment Funnel — End-to-End Processing Flow
Application through CMS confirmation · QTD
↑ Healthy
Avg Time-to-Enroll
4.2 days
STP Rate
87.4%
NIGO Rate
3.1%
Rejection Rate
1.4%
Monthly Enrollment Volume
MAPD vs PDP new enrollments by month
QTD View
Plan mix — Active Members
MAPD 68% · 594,810
PDP 32% · 279,502
Billing & Premium Reconciliation
CMS Payment vs Premium Receivables
Monthly amounts in $M · 12-month rolling
On Track
Billing Exceptions
Current open exception queue
1,847 open
Retroactive Adjustments
720(39%)
Dual Eligibility Conflicts
461(25%)
Premium Gaps (SEP/OEP)
368(20%)
CMS File Mismatches
298(16%)
Reconciliation Queue
Top items by dollar impact
| Category | Count | $ Impact | Status |
|---|---|---|---|
| MA Part C Retro | 271 | +$2.1M | ● Clearing |
| PDP Low-Income Subsidy | 184 | -$1.2M | ● Review |
| OEP Late Enrollment | 127 | -$610K | ● Escalated |
| Dual-Eligible MMP | 103 | +$430K | ● Pending |
| CMS TRR Variance | 61 | -$190K | ● Resolved |
Operational Health
Operational KPI Trends — 8-Week Rolling
SLA compliance, manual intervention rate, error trends, and processing velocity
SLA Compliance
95.7%
Target ≥ 93% · Trend: ▲ improving
Manual Intervention Rate
7.1%
Target ≤ 10% · Trend: ▼ decreasing
CMS File Reject Rate
0.8%
Target ≤ 1.5% · Trend: ▼ stable