Solution Bundle

Dual Enrollment Advocate™ & Recert Complete®

A consumer-centric solution for payers that want to optimize revenue and member satisfaction by helping members obtain and retain added benefits through dual eligible enrollment and recertification services.

 

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Solutiondesigned to Increase Your Dual Enrolled Population

  • Enhance dual eligible identification with our industry-leading AI predictive model that pinpoints with up to 93%* accuracy those individuals with the highest likelihood to qualify for full or partial dual eligibility.
  • Optimize revenue with enhanced risk adjusted payments and more consistent, reliable monthly CMS payments attributed to more dual enrolled members.
  • Support advanced industry ratings by making a positive impact on Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores and CMS Star ratings.
  • Facilitate financial security for members, adding to their monthly income to create more secure personal circumstances.
  • Boost member satisfaction and loyalty by helping Medicare members receive the valuable added benefits they’re entitled to.
  • Help improve member health with added benefits that can encourage members to seek care and manage their chronic conditions.

*results may vary by payer plan and member demographics

End-to-End Dual Eligible Identification and Enrollment

  • Proactive identification

    • Use our industry leading artificial intelligence to predictively identify dual eligibles in your member population with more precision.
    • Apply the power of machine learning to more accurately identify the likelihood of full and partial dual eligible beneficiaries.
    • Live advocates proactively engage with members, once identified, to understand their situation and evaluate eligibility.

  • Easy enrollment

    • Experienced associates assist members with enrollment to help them complete and submit all necessary forms to appropriate state agencies.
    • Live advocates use tactics honed by behavioral science practices and real member feedback to help earn trust and facilitate the enrollment process.
    • Leverage scalable, cost-effective member outreach that can help to reduce member abrasion with our streamlined engagement and communications process.
    • Let us monitor Medicaid status data and advocate on behalf of members to submit appeals and help overturn denials with the support of our experienced government relations team.

  • Recertification

    • Help ensure Medicaid status is retained through our annual engagement with your dual enrolled members that guides them through the recertification process.
    • Allow us to monitor Medicaid status data to ensure we can help advise members regarding redetermination dates and any eligibility changes.
    • Let our team help manage eligibility dispute resolutions and provide monthly member reports to keep you informed.

Providing Measurable Value

3.3 B

Medicaid add-on net revenue to our clients to date (636,000+ dual enrollments and >1 million Medicaid recertifications completed) 1

1 Results based on historical data; results may vary by payer plan and member demographics

46.6 %

Increase in member retention (13.2 months) for Change Healthcare assisted duals, representing an average Medicaid add-on revenue increase of ~$13,000 per retained member

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4.4 B

Part B premium savings achieved for our clients’ dual enrolled members to date

Our outcomes

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Resources and brochures

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Infographic: fusing artificial and human intelligence to optimize dual enrollments

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