Health Plan Revenue Growth Opportunities

Dual eligibility and Low Income Subsidy outreach, retention and other member management for Medicare Advantage plans.
SSI outreach and enrollment for Medicaid managed care plans.

Services for Medicare Advantage Plans

PremiumAssist^SM Dual Eligibility Outreach & Retention Service helps determine potential eligibility of Medicare Advantage plan members for Medicare Savings Programs, assists those eligible to apply (each year), and enables plans to get (and maintain) higher capitation from the Centers for Medicare & Medicaid Services as a result.
Part D Solutions^SM helps determine eligibility of Medicare Advantage and prescription drug plan members for the Low Income Subsidy that pays all or part of their Part D premium and related costs.
Medicaid Documentation and Adjustment Service identifies discrepancies and disconnects between state and federal Medicaid/dual status listings and then provides documentation so health plans can apply for reimbursement at corrected, higher payment levels as well as retrospective adjustments.
SNP Member Re-determination Service helps special needs plans for dual eligibles optimize member management through proactive Medicaid re-determination of their existing members. Specialized reporting helps plans meet CMS requirements for both pre- and post-enrollment Medicaid verification.
Member Complete^SM results from a partnership with the National Council on Aging. Member Complete combines advanced technologies and applications that allow us to offer members assistance to enroll in community programs for which they qualify.

Best Benefits^SM for the Aged, Blind and Disabled helps Medicaid managed care health plans identify members with disabilities and assist in the Supplemental Security Income application process. When done in states in which governments pay higher capitation rates for the disabled populations, this increases payments to those members and increases capitation to the plans.

Best Benefits^SM Medicare Conversion Service for Small Employer Groups is the complete solution for commercial insurance plans to the challenges of Supplemental Security Income/Social Security Disability Income enrollment for their disabled members and the opportunities of Medicare conversion.

2009 - 2010 Federal Poverty Level calculations are shown by family size, broken out into annual, monthly and hourly terms, and also presented in multiplied form (120%, 135%, 150%, 200%, 250%, 300%, 350%, and 400%).