Health Insurance

EvolveNXT’s core focus is health insurance distribution, with deep specialization in Medicare Advantage and support for commercial lines including group, individual, and family business. The platform supports end-to-end producer lifecycle management from onboarding and Ready-to-Sell through incentive compensation and producer self-service. Built for high-volume processing, carrier-grade compliance requirements, and operational transparency across  distribution channels (external, internal, retail, etc.). 

MA support includes integration with CMS (MARx and monthly membership files) to ensure accurate, guideline-driven compensation. The platform supports the full set of CMS payment scenarios, including new-to-Medicare, new-to-carrier, renewal payments, and chargebacks, with configurable logic and audit-ready reporting. Producers and agencies are supported through a unified portal experience that reduces administrative burden while improving visibility into status, earnings, and required actions. 

Core Features

Producer Onboarding, Contracting & Ready-to-Sell

  • End-to-end onboarding workflows for internal and external distribution 
  • Ready-to-Sell status tracking with requirement-level visibility and tasking 
  • Medicare-specific onboarding support, including linking onboarding workflows to: 
    • Medicare certifications 
    • Required training / annual recertification tracking 
  • Delegated access and downline visibility for agencies and distribution organizations 

Medicare Advantage Compensation (CMS-Aligned)

  • Direct integration with CMS MARx and monthly membership files 
  • Support for CMS compensation guidelines and payment scenarios including: 
    • New-to-Medicare (NTM) 
    • New-to-Carrier (NTC) 
    • Renewals 
    • Full and prorated chargebacks 
  • Membership-level traceability for payment decisions and adjustments 
  • Automated processing for high-volume monthly cycles 

Incentive Compensation: Commissions, Bonuses & Adjustments

  • Commission calculation and payout for a broad range of health plans and products 
  • Bonus program support including: 
    • Growth incentives 
    • Persistency/retention incentives 
    • Carrier-defined performance programs 
  • Recurring adjustments and configurable payout timing 
  • Full earned/unearned tracking and adjustment visibility where applicable 

Commercial & Group Compensation Support

  • Support for commercial business models including: 
    • Group 
    • Individual & Family (IFP) 
    • Supplemental health distribution scenarios as applicable 
  • Flexible commission models, including: 
    • % of premium 
    • Per Subscriber Per Month (PSPM) 
    • Per Member Per Month (PMPM) 
    • Premium and member/subscriber tiering  
  • Support for effective dating and product/plan/channel variation in commission schedules 

Hierarchy & Distribution Channel Management

  • Effective-dated hierarchy management with rules-based relationships 
  • Support for multi-level distribution structures: 
    • Producer / agency 
    • Uplines/downlines 
    • Marketing organizations 
  • Clear allocation logic for commissions, overrides, and program eligibility 

Producer Portal (Unified Producer Experience)

  • Single entry point for producer self-service across lifecycle and compensation 
  • Portal access to: 
    • Onboarding and RTS status 
    • Certification/training status (Medicare) 
    • Commission statements and payment history 
    • Dashboards and reporting 
    • Profile, banking, and payee information maintenance 
  • Targeted notifications and required-action alerts

Producer Services & Support (Optional)

  • Producer services support workflows including: 
    • Ticketing/case management 
    • Optional chat support 
  • Communication tools for broad and targeted messaging: 
    • Statement availability 
    • RTS updates 
    • Training reminders 
    • Bonus eligibility and program updates 

Reporting, Analytics & Auditability

  • Standard and configurable reporting for: 
    • Commissions and bonuses 
    • Chargebacks and adjustments 
    • Membership/payment detail (Medicare) 
    • Performance program eligibility and payouts 
  • Audit-ready traceability to support: 
    • Producer inquiries and disputes 
    • Compliance and finance review 
    • Operational reporting and carrier governance 

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See Evolves solutions in action and learn how our purpose-built platform helps carriers drive performance, simplify operations, and scale growth.