PremiumAssist Dual Eligibility Documentation and Adjustment Services
- Helping plans receive proper retroactive increased capitation for the dual enrolled.
- Reducing plan work loads by compiling all materials needed for adjustment success.
What We Do
PremiumAssist Dual Eligibility Documentation and Adjustment Services help assure that our health plan clients receive the proper retroactive increased capitation for dual eligible (Medicare + Medicaid) plan members. Because there can be frequent processing issues between state and federal agencies, disconnects commonly result in which dual eligible Medicare Advantage health plan members are dual-enrolled according to Medicaid records but are not “capitated” as such to Medicare Advantage health plans. PremiumAssist Dual Eligibility Documentation and Adjustment Services work to:
- Identify these kinds of discrepancies.
- Provide all documentation that allows the plan to submit data to receive reimbursement at the right payment level and get retrospective adjustments.
Why Eligibility Documentation Services are Relevant
Because of the diversity of agencies involved in coordinating Medicaid enrollment at numerous levels, disconnects happen for a variety of reasons. In fact, delayed capitation increases can mean significant deferred income for Medicare Advantage health plans, in many cases amounting to millions of dollars. On an individual basis, this type of error can delay -- or even negate -- the appreciable increase in discretionary income that a Medicaid program represents for successfully dual-enrolled members. To address these issues successfully (getting the right level of capitation and securing retrospective capitation adjustments) is a complex process requiring significant expertise at various state and national levels. PremiumAssist Dual Eligibility Documentation and Adjustment Services are unparalleled in these respects.
Major Benefits
- Income optimization– for the Medicare Advantage health plan.
- Optimized compliance and lower risk – because critical documentation to support questioned eligibility is well-maintained.
- Minimized staff work – because Human Arc does all the research and prepares all the documentation to substantiate plan submissions for retrospective status corrections.
The Human Arc Edge
Human Arc's PremiumAssist Dual Eligibility Documentation and Adjustment Services deliver unmatched advantages:
- Experience with state Medicaid infrastructures – Human Arc has over two decades of experience with Medicaid enrollment through most states’ agencies and across the widest possible array of programs of eligibility. Our approach of mutual respect and assistance to these infrastructures has won us cooperation in securing needed data.
- Proven processes, documentation thoroughness and adjustment request effectiveness – Our clients often secure positive results and timely response from IntegriGuard in processing adjustment and removal transactions.
- Proven Rewards – We document how we have produced multi-million-dollar revenue enhancements for plans through retrospective adjustments, plus how these adjustments yield significant prospective CMS capitation payments, compounding the positive bottom line impacts of these projects.
Medicaid Special Status Enhancement Services Case Studies
Nothing speaks like proof, so here’s how these services have helped clients.