Eligibility and Enrollment

Streamlining Eligibility And Enrollment For Maximum Efficiency

Cognosante's eligibility practice is built on over 25 years of health IT experience, including extensive work in Medicaid and MITA. Our understanding of ACA, MITA, and CMS' Seven Conditions and Standards provides the foundation for an integrated eligibility solution that meets today's standards while maximizing efficiency and effectiveness. Our experience with MAGI also accounts for state-specific rules, conditions as well as non-MAGI programs.
Meeting Your Challenges 
From replacing legacy eligibility and enrollment systems to improving business processes and optimizing business rules, we offer a transformational Integrated Eligibility and Enrollment (IE&E) solution that provides a seamless superhighway for eligibility determination, enrollment, and renewal to meet today's growing enrollment rolls while ensuring compliance with ACA, the Seven Conditions and Standards, and other mandates.
Cognosante's eligibility solution consists of carefully selected and proven commercial off-the-shelf (COTS) products. For most eligibility projects, our solution provides at least 80% functionality out of the box. We believe a COTS eligibility solution provides a quicker implementation time, better value, lower cost of investment, and flexibility to adapt to program changes with low implementation risk. Moreover, Cognosante's eligibility solution is designed with future operations, maintenance costs, and risks in mind.
Our Solutions and Services

We provide a wide range of expertise and services to design, procure, implement and transform your Eligibility and Enrollment system including:


  • Project Management
  • System Integration Services
  • System/Business Requirements and Gap Analysis
  • Business Process and Business Rules Analysis and Modeling
  • Eligibility Engine Business Rules
  • Business Process Reengineering and Change Management
  • Federal Compliance – Gate review process and artifacts
  • Technical Architecture – CMS Seven Conditions and Standards and MITA


The Cognosante Difference


  • Unsurpassed Knowledge and Expertise: With over 25 years of experience working with Medicaid and integrated eligibility systems, we have a successful record of implementations and unmatched knowledge of state and federal eligibility rules.


  • Compliance Confidence: With extensive experience performing MITA state self-assessments, meeting CMS' Seven Conditions and Standards, achieving qualification for Enhanced Federal Funding guidelines, and other mandates, we deliver compliance and a peace of mind.


  • Total Interoperability: Our interfaces utilize HIPAA, the Health IT Policy Committee, the National Information Exchange Model (NIEM), CAQH, and NIST standards to ensure complete interoperability.


  • A Future-Ready Enrollment Solution: We deliver a seamless, one-stop-shop solution for eligibility determination, enrollment, and renewal that can easily be extended to your Health Information Exchange or Electronic Health Record system.