Eligibility & Enrollment

Pool Administrators Inc. employs a team approach to the eligibility and enrollment function, which allows us to draw upon the expertise of our whole organization. In order to improve the processing accuracy and timeliness for our customers, and to allow for the integration of best practices and knowledge sharing, our Customer Service Representatives are cross-trained on program eligibility and enrollment policies, procedures and contract requirements.

PAI develops detailed Eligibility and Enrollment documentation for each program.  These policy and procedure documents are thoroughly reviewed and tested by PAI staff in order to provide an accurate, comprehensive resource for each program, and ensure consistent process application. Additionally, auditing of processed Eligibility and Enrollment data is routinely performed to make certain that data is processed correctly, as well as to identify any additional training opportunities for the staff.   

PAI electronically transmits eligibility data to carriers and other external entities via HIPAA compliant methods to ensure the security of the transmitted data. Transmission frequency is dependent upon program requirements. PAI Customer Service Representatives place a high emphasis on confidentiality and are trained in HIPAA requirements. They are also experts in effective communication across populations, and are able to convey the intricacies of the enrollment process via techniques that are efficient and professional, yet compassionate and responsive.