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Medicaid Managed Care
Increasing Enrollment and Member Retention
Due to the transient nature of the Medicaid eligible population and the challenge of keeping up with re-determination requirements, Medicaid managed health plans are looking for solutions to control member churn.
HelpEngen supports member outreach and retention activities by enabling health plans to notify members of their need to renew Medicaid eligibility well ahead of deadlines and, when necessary, perform eligibility assessment to establish whether they meet the requirements for continuing participation in the plan and prepare the appropriate re-enrollment forms for filing.
Because HelpEngen archives member data and required supporting documentation, successive re-enrollment and re-determination involves much less effort, minimizing staff work and reducing administrative costs.
The result is a demonstrated increase in member retention.
Medicare Advantage
“Dual Eligible” Outreach and Retention
Only half of low-income elderly and disabled individuals who qualify for both Medicare and Medicaid are actually enrolled in both programs. For Medicare Advantage plans, identifying and enrolling members in Medicare Savings Programs [SLMB,QMB, QI] and/or full Medicaid, can represent increased revenues from higher capitation rates while maximizing benefits to those plan members who are most in need.
HelpEngen enables Medicare Advantage plans to implement a systematic, prospective process to help existing members establish and maintain dual-eligible status as well as to confirm dual eligibility at initial enrollment for new members.
HelpEngen can also help connect plan members to non-medical assistance for heating and food stamps, for example. Adding social program outreach has the potential to impact medical utilization by improving member lifestyles and further reduce churn by increasing member loyalty.
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