Medicare Advantage Dual Eligible Assistance
Improve member satisfaction and retention through MSP advocacy
MEDICARE SAVINGS Complete™
MEDICARE SAVINGS Complete is the branded core program of Altegra Health’s dual eligible outreach, advocacy and retention services. Medicare Savings Programs (MSPs) are available to all Medicare beneficiaries who meet certain financial (income and asset) qualifications established by the federal government and which are administered by the Medicaid eligibility authority in each state.
Altegra Health currently assists more than 70 Medicare Advantage (MA) plans to identify individuals who are likely to qualify for enrollment in a MSP, conducts outreach and education about the benefits of MEDICARE SAVINGS Complete, and advocates on behalf of interested members. Altegra Health then completes and submits the necessary forms to appropriate state agencies.
- Predictive Modeling – Utilize Altegra Health’s proprietary algorithmic method to predict each Medicare beneficiary’s likelihood for dual eligibility based on several key demographic and socio-economic factors (e.g., age, gender, disability, race, ethnicity, income, household composition, geography, etc.).
- Trusted Experience – Access key sets of data that are available to Altegra Health through numerous sources, including our own historical database of more than 5 million MA plan enrollees.
- Stratified Population Management – Stratify your Medicare population on the basis of which, if any, social programs members will likely qualify for – all based on a dual eligibility likelihood score of between 1 and 1,000 for each beneficiary.
- Know Your Members – Prioritize outreach campaigns, messaging and outreach methods based on the member’s eligibility likelihood score.
Extra Help (Part D) Program
Altegra Health’s PART D Complete™ identifies Medicare beneficiaries who qualify for the Medicare Prescription Drug Coverage Extra Help and facilitates the completion of their application for and enrollment into the program. This program allows qualifying seniors and the disabled to receive prescription medication at a discounted rate.
- Manage Risk and Benefits – Help MA prescription drug plans (MAPDs) and prescription drug plans (PDPs) reconcile Part D benefit categorization for program participants, an instrumental step to ensure appropriate revenue associated with each Extra Help enrolled beneficiary’s risk profile.
- Efficient Submission Processes – Process Extra Help application submissions with Altegra Health’s on-line system, rapidly facilitating recognition on the health plan’s MMR, which will in turn serve to minimize reprocessing of drug encounter claims, participant reimbursement, and information submitted to the Social Security Administration.
Help dual enrolled members successfully complete the annual recertification process
Each year, in order for members to retain their Medicaid status, they must complete the recertification process in accordance with their state’s Medicaid policy. With RECERT Complete™, Altegra Health acts on health plan members’ behalf by helping to ensure they do not miss the annual deadline and advocate on their behalf to re-enroll into these important programs.
Existing dual enrollment in both the Medicare and Medicaid programs (including Medicare Savings Programs) is a prerequisite for joining a dual eligible Special Needs Plan (SNP). Thereafter, SNP members must retain their dual enrollment status by completing the annual redetermination or recertification process administered by their state’s Medicaid administration. Altegra Health’s RECERT Complete helps dual enrolled MA members, who became dual enrolled on their own or through a third-party advocate other than Altegra Health, to complete the annual recertification process.
- Recertification Correspondence – Send reminder notifications to dual enrolled members in 90-, 60-, and 30-day increments in advance of the annual expiration date of their current Medicaid coverage period, prompting them to also gain guidance on completing the process with the help of an Altegra Health advocate or on their own.
- Follow-up Phone Calls – Prompt dual enrolled members to complete the recertification on their own or call Altegra Health for assistance in completing the required paperwork as soon as members approach the renewal date of their current Medicaid enrollment period.
- Completion of Recertification Forms – On behalf of dual-enrolled members who elect to leverage assistance and guidance of an Altegra Health Advocate, we will assist in gathering and submitting applicable verifications.
- Eligibility Dispute Resolution – Help members resolve disputes that might otherwise result in a member’s recertification application being denied.
- Monthly Membership Report Monitoring (MMRs) – Altegra Health monitors the MMR from the Centers for Medicare & Medicaid Services, ensuring ongoing Medicaid status is reflected accurately.
24/7 Web service for members seeking assistance with their healthcare
My Advocate Helps (MyAdvocateHelps.com) is a technology-enabled concierge-style outreach service provided to health plan representatives and their members. It is designed to help Medicare Advantage, Managed Medicaid, and Commercial health plan members save money, receive needed assistance, and improve their health quality. This internet-based eligibility screening tool determines which social and quality of life programs a member may qualify for from among the thousands of [publicly and privately sponsored] programs included in Altegra Health’s COMMUNITY Link™ database.
- Community Program Support – Assist health plan members with enrollment into an array of community programs and to gain a comprehensive understanding of the numerous public and private benefits available to them.
- Provide Value Without Interruptions – Provide a valuable service while conducting uninterrupted sales operations during the lock-in period.
My Advocate Helps App. Our smartphone app (Availaable in the App Store) is an engaging communication tool providing health plan members with educational and interactive programs to enhance their care and quality of life. The app includes a member interview tool to discover health-related community programs; educational programming specific to the health needs of the member; chat functionality to encourage direct dialogue between the member and health plan; and clear, relevant insights for health plans to view, track and measure member engagement data.
Find out more about how My Advocate can help your members and your bottom line: