Millions of dual-eligible seniors are falling through the cracks. The cost — human and financial — is staggering. It doesn’t have to be this way.
SAN FRANCISCO, CA, UNITED STATES, March 2, 2026 /EINPresswire.com/ — Right Skale Inc. launched DualEnroll.ai for Payors , its AI-enabled platform developed to support Medicare Advantage, D-SNP, and Medicaid Managed Care Organizations in coordinating enrollment and renewal processes for dual-eligible beneficiaries.
According to the Centers for Medicare & Medicaid Services (CMS), approximately 12–13 million individuals in the United States qualify as dual-eligible, meaning they are enrolled in both Medicare and Medicaid. MedPAC has reported that dual-eligible beneficiaries account for a disproportionate share of Medicare and Medicaid spending due to higher care needs and chronic conditions.
Because dual eligibility requires coordination across federal Medicare systems and state Medicaid systems, enrollment and recertification workflows often involve multiple data sources and regulatory requirements.
Addressing Administrative Coordination
– Health plans managing dual-eligible populations may navigate:
– Federal Medicare eligibility systems
– State Medicaid eligibility portals
– Special Enrollment Period (SEP) rules
– Recertification documentation requirements
– CMS compliance reporting standards
CMS has also noted the importance of coordination in Dual Eligible Special Needs Plans (D-SNPs) to improve alignment between Medicare and Medicaid benefits.
“Dual enrollment requires coordination across multiple administrative and regulatory frameworks,” said Puneet Shivam, CEO of Right Skale. “DualEnroll.ai was designed to provide health plans with structured automation and data visibility to support these operational processes.”
Operational Pressures Reported by Plans Include:
Enrollment Teams
– Manual cross-checking across five or more systems
– Re-keying existing data
– Confirming eligibility via state portals
Health Plans
– Estimated $85–$120 per application in manual processing costs
– Missed capitation and quality bonus opportunities
– Increasing CMS compliance oversight
Members
– Enrollment decisions averaging three weeks
– Delays in accessing LIS, Extra Help, and related assistance programs
– A Modernized Approach to Dual Enrollment
DualEnroll.ai was designed specifically for payors seeking to streamline enrollment operations while maintaining regulatory compliance.
The platform enables:
– Real-Time Eligibility Integration
API connections to Medicare, Medicaid, SSA, and state databases
– Parallel Multi-Program Screening
Automated screening for D-SNP, LIS, Extra Help, SNAP, and utility assistance
– Automated Special Enrollment Period (SEP) Detection
Built-in compliance workflows
– Flexible Deployment Options
On-premise or private cloud deployment aligned with organizational data governance
– AI-Enabled Decision Support
Automation of intake workflows while preserving human oversight
Organizations utilizing the platform have reported:
– Processing time reduced from 23 days to under 3 days
– Per-application costs reduced 40–60%
– Increased benefit capture rates
– Embedded audit-readiness aligned with CMS requirements
About Right Skale Inc.
Right Skale Inc. is a Silicon Valley-based AI transformation firm with global delivery teams. DualEnroll.ai is its purpose-built platform for Medicare Advantage, D-SNP, and Medicaid Managed Care Organizations — focused on improving enrollment efficiency, reducing administrative costs, and increasing benefit capture.
For more information or to schedule a live demonstration:
www.DualEnroll.ai
support@dualenroll.ai
Amit Shah
Right Skale
email us here
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