Ten ways Rendum pays for itself.
Purpose-built functionality for vendors and plans operating in capitated, roster-driven billing relationships. Currently serving Medicare Advantage supplemental benefit vendors, with the same engine resolving Managed Medicaid Managed Care Organization, capitated provider, and plan-side reconciliation use cases on the roadmap.
Centers for Medicare and Medicaid Services Encounter Data Record Pre-Stage
From eligibility file to CMS-ready in one pass.
The Rendumized Roster is enriched with everything a Medicare Advantage payer needs to generate encounter data records: Supplemental Benefit Services Category codes, Paperwork indicator fields, date ranges, charge and paid amounts, combined-benefit splits. Your payer drops it straight into their 837 pipeline. The same enrichment pattern applies to Managed Medicaid encounter submissions, which use parallel encounter data standards under state Medicaid managed care contracts.
- Supplemental Benefit Services Category code on every line
- Paperwork indicator fields populated per CMS guidance
- Allowance charge vs. paid amount split for pre-funded cards
- Combined-benefit splits with correct suffix handling
Revenue Leakage Detector
Every dollar you earned but didn't bill.
Continuous scan that surfaces members who should have been billed but weren't — missing retroactive enrollments, members active during the billable day but off the invoice, benefits eligible but never utilized, termination-to-reinstatement gaps never recovered. Dollar-quantified, member-by-member, recoverable before the window closes.
- Real-time dollar impact of missed billable days
- Member-level recovery list with rule citations
- Retroactive window countdown per payer
- Historical leakage trending across quarters
Retroactive Adjustment Workbench
Retroactive changes stop being a fire drill.
A dedicated interface for the retroactive correction cycle. Every enrollment change dated in the past, the billing periods it affects, the dollar impact, the payer's retroactive window policy, and a one-click recalculation that produces adjustment-ready data. Close the window before your payer does.
- Retroactive change inbox with dollar impact preview
- Per-payer retroactive window enforcement
- One-click recalculation with full audit trail
- Adjustment-ready output in payer-specific format
Audit Package Generator
Answer any audit question in five seconds, not five days.
One click produces a complete audit response for any billing decision or member month — the rule version applied, the signed-off contract clause it came from, the named reviewer and date, the eligibility events that triggered the decision, and the member's full timeline. Shareable PDF and machine-readable JSON.
- Per-decision audit package in seconds
- Signed contract clause citation on every record
- Named reviewer attestation with timestamp
- Shareable PDF plus structured JSON export
Payer Reconciliation Engine
Every credit demand comes with a contract-backed response.
Ingest the payer's counter-roster or remittance advice and match it line-by-line against the Rendumized Roster. Every discrepancy surfaces with a contract-grounded defense. Stop writing off disputes you would have won.
- Line-by-line match against payer remittance
- Dispute categorization with contract clause citation
- Dollar variance reporting with resolution tracking
- Structured response export for payer finance teams
- Works against private payer remittances, Centers for Medicare and Medicaid Services Monthly Membership Reports, and state Medicaid capitation files
Contract Change Impact Simulator
Know what every clause is worth before you sign.
Upload a proposed amendment or new payer contract. Rendum extracts the new rules, replays them against your last six months of eligibility data, and produces a before-and-after financial impact report. Walk into every negotiation with quantified leverage.
- Automated rule extraction from draft contracts, Centers for Medicare and Medicaid Services sub-regulatory guidance, and state Medicaid managed care contract amendments
- Historical replay against six months of eligibility
- Revenue delta with member-level drill-down
- Operational change checklist for each clause
Multi-Payer Portfolio Dashboard
Know how you perform against the rest of your category.
A portfolio view across every payer — billable-day capture rate, invoice days-sales-outstanding, dispute rate, reconciliation close time, and revenue per member per payer. With opt-in anonymized benchmarks against the rest of the Rendum customer base in your benefit category.
- Capture rate and dispute rate per payer
- Invoice aging with payer-specific terms
- Category benchmarks from anonymized cohort
- Revenue per member per payer trending
- Cross-program performance: Medicare Advantage, Managed Medicaid, and capitated arrangements in one view
Real-Time Eligibility API
Stop delivering benefits to terminated members.
A Representational State Transfer endpoint your field operations hit before delivering a service. Drivers, care coordinators, installers, retail integrations. Rendum returns eligibility status, benefit remaining, and allowance balance from your already-ingested rosters in under 200 milliseconds, with every decision cached as an auditable event.
- Sub-200ms eligibility verification
- Benefit remaining and allowance balance
- Point-of-service audit logging
- Webhook notifications for status changes
Rule Drift Monitor
Your contract changed. Did your billing?
Continuous monitoring that compares the rules encoded in Rendum against the contracts on file, flagging drift caused by amendments, renewals, or policy letters that weren't propagated. Named reviewers are alerted when rules age past configurable freshness thresholds.
- Automated contract-to-rule drift detection
- Configurable rule freshness thresholds
- Named reviewer alerts with sign-off workflow
- Historical drift log for compliance attestation
Member Timeline with Decision Replay
Every member. Every decision. Every rule that ever applied.
A per-member view of the complete enrollment lifecycle — every file the member appeared in, every event, every billing decision, every retroactive adjustment. Replay the decision engine against historical state to investigate disputes, train new staff, or build audit evidence.
- Complete member enrollment lifecycle view
- File-by-file event provenance
- Decision replay against historical state
- Exportable evidence bundle per member
See it against your own data.
A 30-minute demo with a sample of your eligibility files. Walk away with a projected recovery number and a list of the members you're leaving on the table today.