Group Medicare Administration

Medicare health benefit administration and advocacy are all that we do. Our team employs a dedicated, face-to-face support strategy that is aimed at creating an atmosphere where clients are confident they are receiving the best services available.  Please explore the list below of customized administrative functions we can provide starting day one and continuing through the life of the benefit.

Key Service Functions & Options for the Plan Sponsor:

Dedicated Client Account Management Team:

  • Client Service Vice President (Account Manager)
  • Client Relationship Manager
  • Lead Member Advocate
  • Member Advocate Team
  • Dedicated Pharmacy Technician
  • Dedicated IT & Billing Representatives

Enrollment Type Options:

  • Group Enrollment with Opt-In/Opt-Out Capabilities
  • Voluntary Enrollment (Face-to-face, Online, Telephonic, Mail & Fax)

Member Mailings:

  • Craft and fulfill fund’s customized announcement letters, pre-enrollment kits and welcome kits.
  • Communication pieces custom crafted for retirees to easily understand while adhering to CMS compliance requirements.

Meetings:

  • Educational, Plan Kick-off, Enrollment, On-Going Retiree Group and Wellness Initiative Meetings

Eligibility Scrubbing:

  • Manage all eligibility maintenance in CMS’s approved format, so the client does not need to change their business process. We will adapt our systems to meet the clients needs.
  • Age-In and Dis-Enrollments – Customized enrollment and dis-enrollment process to meet client’s needs.

Member Advocacy Center:

  • Proprietary phone and software system
  • Customized greetings and client phone numbers
  • No dial-by directories, our advocates answer every call
  • 100% domestic with over 300 languages available. TTY compatible.
  • All calls are recorded and stored for 10 years

Billing Capabilities:

  • Direct Client – Group list billing
  • Split billing (Client/Member)
  • Member Direct Bill (100% Member through ACH)
  • Integrated HRA
  • LEP & LIS billing available

Reporting:

  • Member Interaction Reports
  • Customized call Transcriptions Reports
  • Utilization Reporting
  • Customized ad-hoc reporting

Advisory Role:

  • Plan Document Review
  • SPD Revisions

 

Please read more about how our Medicare Benefit Solutions can help plan sponsors or how our Retiree Healthcare Advocacy program can help your retired participants.