Eligibility & Enrollment 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 method directly with members with our real-time advocates.
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.