The Eligibility Intelligence platform for capitated, roster-driven healthcare billing
Rendum replaces manual eligibility checks and spreadsheet calculations with a deterministic, auditable pipeline. Eligibility Intelligence your billing system can trust, whether you operate in Medicare Advantage, Managed Medicaid, or capitated provider arrangements. Currently serving Medicare Advantage supplemental benefit vendors.
What Rendum Does
- Automates eligibility verification from payer files across Medicare Advantage, Managed Medicaid Managed Care Organization, and capitated provider roster sources
- Calculates billable days using deterministic, auditable rules
- Rendumizes your eligible members and delivers a verified billing roster to your system
- Handles retroactive enrollment changes and adjustments
- Tracks member enrollment status across multiple payers
- Provides real-time pipeline monitoring and alerting
- Exports data via REST API, SFTP, CSV, or direct ERP integrations
- Maintains full HIPAA compliance with SOC 2 Type II audit preparation in progress
- Catches overbilling before it generates a credit — and underbilling before it silently disappears
- Provides one authoritative eligibility answer for your billing system and your care management platform
What Rendum Does Not Do
- Does NOT use AI or machine learning in the Rendumizer
- Does NOT replace your care management platform
- Does NOT manage clinical data or treatment records
- Does NOT handle claims adjudication or payment processing
- Does NOT interact directly with CMS or state regulators
- Does NOT require changes to your existing care delivery workflow
- Does NOT store credit card or financial account data
- Does NOT make probabilistic guesses about eligibility
Pre-configured for major Medicare Advantage payers
Rendum's ingestion pipeline is pre-configured for all major Medicare Advantage payers. File format schemas are mapped and validated against published payer specifications. Integration is confirmed against live payer data during onboarding. The same engine is built to absorb Managed Medicaid Managed Care Organizations and capitated provider arrangements as those programs roll out.
| Payer | Type | Status |
|---|---|---|
| UnitedHealthcare | National | Format Configured |
| Aetna / CVS Health | National | Format Configured |
| Humana | National | Format Configured |
| Anthem / Elevance | National | Format Configured |
| Centene | National | Format Configured |
| Cigna | National | Format Configured |
| Molina Healthcare | National | Format Configured |
| Blue Cross Blue Shield | Regional | Format Configured |
| Kaiser Permanente | Regional | In Configuration |
| WellCare | National | Format Configured |
| Tricare | National | Format Configured |
| Devoted Health | Regional | Format Configured |
| Alignment Healthcare | Regional | Format Configured |
| Clover Health | Regional | In Configuration |
| Oscar Health | Regional | In Configuration |
| Custom Payer | Any | Configurable |
Format Configured: ingestion schema mapped and pipeline validated against published payer file specifications. Production validation occurs during customer onboarding with live payer data.