Implementation & Getting Started
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How long does implementation typically take?
Most health plans are up and running within 6-8 months, depending on your current system complexity and data migration needs. We've streamlined the process because we know you can't afford extended downtime. Our implementation team handles the heavy lifting, including data migration, system configuration, and staff training.
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What happens to our existing data during implementation?
Your data stays secure and accessible throughout the entire process. We perform comprehensive data mapping and validation before migration, ensuring nothing gets lost in translation.
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Do we need to shut down operations during the transition?
No. We design implementations to minimize disruption to your daily operations. Critical functions, like enrollment and billing, continue running while we configure and test your new system in the background.
Integrations & Technical Requirements
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Will Miramar:Member integrate with our existing systems?
Yes. The platform connects with your claims processors, pharmacy benefit managers (PBMs), financial institutions, and other key systems through robust APIs. We also integrate seamlessly with CMS and external enrollment portals. If you have a unique system, our technical team will work with you to build the necessary connections.
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What if we use a non-standard claims processor or PBM?
We've integrated with many different systems over the years. Even if we haven't worked with your specific vendor before, our API-first architecture makes new integrations straightforward. We'll handle the technical work—you won't need to change your existing vendor relationships.
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How does the platform handle real-time data synchronization?
Miramar:Member uses real-time APIs and automated reconciliation processes to keep all your systems in sync. When a member's coverage changes, that update flows automatically to billing, claims, and any other connected systems. No more manual data entry or waiting for overnight batch processes.
CMS Audit Readiness & Compliance
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How does Miramar:Member help with CMS audits?
The platform is designed with audits in mind. Every transaction is logged, every workflow includes built-in compliance checks, and all your data is organized in audit-ready formats. When CMS comes calling, you'll have everything they need at your fingertips—no scrambling to pull reports from multiple systems.
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What specific CMS requirements are built into the platform?
All of them. Late enrollment penalties, required documentation, HPMS notifications, enrollment verification, premium billing rules. If CMS requires it, it's automated in Miramar:Member. The platform updates automatically when regulations change, so you're always compliant without having to track every regulatory update yourself.
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How do you handle regulatory changes and updates?
Our compliance team monitors CMS guidance continuously and pushes updates to the platform automatically. You'll get advance notice of any changes that might affect your operations, along with clear guidance on what (if anything) you need to do. Most updates happen behind the scenes without any action required from your team.
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Can the platform generate the reports CMS typically requests during audits?
Absolutely. We have more than 100 standard reports built into the platform, including all the formats CMS typically requests. Plus, you can run ad hoc queries and access your data warehouse directly when you need custom analysis. Everything is designed to be audit-ready from day one.
IT Requirements & Technical Lift
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What kind of IT resources do we need to support Miramar:Member?
Minimal. The platform is cloud-based and fully managed by our team. Your IT department won't need to maintain servers, manage updates, or handle technical troubleshooting. Most plans find they can actually reduce their IT overhead after implementing Miramar:Member.
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Do we need dedicated IT staff to manage the platform?
No. The platform is designed for business users, not IT specialists. Your enrollment, billing, and member services teams can manage day-to-day operations without technical support. For any system-level issues, our support team handles everything remotely.
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What about security and data protection?
Security is built into every layer of the platform. We maintain HITRUST certification, HIPAA compliance, and follow all CMS security requirements. Your data is encrypted in transit and at rest, with role-based access controls and comprehensive audit trails. We handle all security updates and monitoring so you don't have to.
All updates happen automatically during scheduled maintenance windows between 2:00-7:00 am Eastern. You'll get advance notice of any major updates, but most happen seamlessly without affecting your operations. No more coordinating with multiple vendors or managing complex update schedules.
Support Structure & Ongoing Partnership
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What kind of support do you provide after implementation?
Comprehensive support that goes beyond just answering technical questions. You get a dedicated account team that understands your business, timely technical support for urgent issues, regular check-ins to optimize your operations, and proactive guidance on regulatory changes. Think of us as an extension of your team.
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How quickly do you respond to support requests?
For urgent issues affecting CMS critical compliance issues, we respond within .5 business hours. For general questions and non-urgent requests, you will receive a response within 24 business hours. Most issues are resolved on the first call. Our support team has deep knowledge of both the platform and Medicare operations.
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Do you provide training for our staff?
Yes, comprehensive training is included. We provide initial training as part of implementation, and the platform’s intuitive design allows most staff to become proficient quickly. Our team is always available for additional support whenever questions arise.
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What happens if we need custom features or modifications?
We work with you to understand your specific needs and determine the best approach. Many requests can be handled through the platform's configuration options. For truly custom requirements, we evaluate whether it makes sense to build into the core platform (benefiting all clients) or create a client-specific solution.

